慢性粒-单核细胞白血病骨髓活检病理学分析
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摘要
目的 :分析慢性粒-单核细胞白血病(chronic myelomonocytic leukemia,CMML)的细胞形态学特点,为对照,探索免疫标记物在CMML诊断中的意义及临床应用价值。方法:采用骨髓活检病理组织学方法分析39例CMML的病理学特点;采用免疫组化法,以CMML为实验组,慢性粒细胞白血病(chronic myelocytic leukemia,CML)及急性单核细胞白血病(acute monocytic leukemia,AMo L)为对照组,检测CD15、MPO、CD34、CD14、CD56、CD68(PG-M1)、CD163在上述3组中的表达。结果 :CMML骨髓病理组织学提示33例(84.6%)骨髓增生极度活跃,粒系细胞增生明显且形态异常,29例(74.4%)单核细胞增多,20例(51.3%)巨核细胞形态异常。粒细胞标记物CD15、MPO在CMML中的阳性表达率分别为(21.69±7.06)%,(33.96±5.94)%,其与CML及AMo L均有统计学差异。单核细胞标记物CD14、CD56、CD68(PG-M1)及CD163的阳性表达率分别为(10.10±2.51)%、(8.69±2.66)%、(13.35±4.32)%、(11.43±4.15)%,除CD56外,其余在CMML与AMo L的阳性率均有明显差异。原始细胞标记物CD34的阳性表达率为4.31±1.98%,与CML有统计学差异。结论:骨髓病理组织学及免疫组化有助于CMML的诊断及鉴别诊断。
Objective:To analysis the cell morphological characteristics in chronic myelomonocytic leukemia(CMML),and investigate the expression of immune marker in the diagnose and clinical application value of CMML. Methods:Using the bone marrow biospy pathology to analysis the pathology characteristics in 39 cases of CMML. By using the immunohistochemistry to detect the expression of antibodies which included CD15,MPO,CD34,CD14,CD56,CD68(PG-M1)and CD163 in CMML,comparison with chronic myelocytic leukemia(CML) and the acute monocytic leukemia(AMo L) patients. Results:Hypercellularity was the markedly feature of the bone marrow histology in 33 cases(84.6%)of CMML. Increased granulocytic proliferation and obviously morphological abnormalities were observed in these cases. Monocytic cells were increased in 29 cases(74.4%)and 20 cases(51.3%)presented megakaryocytic morphological abnormalities. The marker in the granulocytic lineage expresses CD15 and MPO,which had respectively positive percentage of 21.69 ± 7.06% and 33.96 ± 5.94%,there were significantly statistical differences compared with CML and AMo L. The marker in the monocytes expresses CD14、CD56、CD68(PG-M1)and CD163,which were positive(10.10 ± 2.51)%、(8.69± 2.66)%、(13.35 ± 4.32)%、(11.43 ± 4.15)%,respectively. Except from CD56 positive CMML and AMo L,the rest had significantly statistical differences. The original marker which was positive expressed in CMML such as CD34 had the percentage of(4.31 ± 1.98)%,which had significantly statistical differences with CML. Conclusion:Morphological and immunohistochemical features of bone marrow biopsy are helpful in the diagnosis and differentiation.
Objective:To analysis the cell morphological characteristics in chronic myelomonocytic leukemia(CMML),and investigate the expression of immune marker in the diagnose and clinical application value of CMML. Methods:Using the bone marrow biospy pathology to analysis the pathology characteristics in 39 cases of CMML. By using the immunohistochemistry to detect the expression of antibodies which included CD15,MPO,CD34,CD14,CD56,CD68(PG-M1)and CD163 in CMML,comparison with chronic myelocytic leukemia(CML) and the acute monocytic leukemia(AMo L) patients. Results:Hypercellularity was the markedly feature of the bone marrow histology in 33 cases(84.6%)of CMML. Increased granulocytic proliferation and obviously morphological abnormalities were observed in these cases. Monocytic cells were increased in 29 cases(74.4%)and 20 cases(51.3%)presented megakaryocytic morphological abnormalities. The marker in the granulocytic lineage expresses CD15 and MPO,which had respectively positive percentage of 21.69 ± 7.06% and 33.96 ± 5.94%,there were significantly statistical differences compared with CML and AMo L. The marker in the monocytes expresses CD14、CD56、CD68(PG-M1)and CD163,which were positive(10.10 ± 2.51)%、(8.69± 2.66)%、(13.35 ± 4.32)%、(11.43 ± 4.15)%,respectively. Except from CD56 positive CMML and AMo L,the rest had significantly statistical differences. The original marker which was positive expressed in CMML such as CD34 had the percentage of(4.31 ± 1.98)%,which had significantly statistical differences with CML. Conclusion:Morphological and immunohistochemical features of bone marrow biopsy are helpful in the diagnosis and differentiation.
引文
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[6]Lacronique-Gazaille C,Chaury MP,Le Guyader A,et al.A simple method for detection of major phenotypic abnormalities in myelodysplastic syndromes:expression of CD56 in CMML[J].Haematologica,2007,92(6):859-860
[7]Naresh KN.Morphological evaluation of monocytes and monocyte precursors in bone marrow trephine biopsiesneed for establishing diagnostic criteria[J].Haematologica,2009,94(11):1623-1624
[8]Germing U,Strupp C,Knipp S,et al.Chronic myelomonocytic leukemia in the light of the WHO proposals[J].Haematologica,2007,92(7):974-977
[9]Orazi A,Chiu R,O'Malley DP,et al.Chronic myelomonocytic leukemia:The role of bone marrow biopsy immunohistology[J].Mod Pathol,2006,19(12):1536-1545
[10]Della PM,Malcovati L,Boveri E,et al.Clinical relevance of bone marrow fibrosis and CD34-positive cell clusters in primary myelodysplastic syndromes[J].J Clin Oncol,2009,27(5):754-762
[2]Qubaja M,Marmey B,Le Tourneau A,et al.The detection of CD14 and CD16 in paraffin-embedded bone marrow biopsies is useful for the diagnosis of chronic myelomonocytic leukemia[J].Virchows Arch,2009,454(4):411-419
[3]Cibull TL,Thomas AB,O'Malley DP,et al.Myeloid leukemia cutis:a histologic and immunohistochemical review[J].J Cutan Pathol,2008,35(2):180-185
[4]Xu Y,Mc Kenna RW,Wilson KS,et al.Immunophenotypic identification of acute myeloid leukemia with monocytic differentiation[J].Leukemia,2006,20(7):1321-1324
[5]Kojima H,Bai A,Mukai HY,et al.Chronic yelomonocytic leukemia derived from a possible common progenitor of monocytes and natural killer cells[J].Leuk Lymphoma,2000,37(5-6):617-621
[6]Lacronique-Gazaille C,Chaury MP,Le Guyader A,et al.A simple method for detection of major phenotypic abnormalities in myelodysplastic syndromes:expression of CD56 in CMML[J].Haematologica,2007,92(6):859-860
[7]Naresh KN.Morphological evaluation of monocytes and monocyte precursors in bone marrow trephine biopsiesneed for establishing diagnostic criteria[J].Haematologica,2009,94(11):1623-1624
[8]Germing U,Strupp C,Knipp S,et al.Chronic myelomonocytic leukemia in the light of the WHO proposals[J].Haematologica,2007,92(7):974-977
[9]Orazi A,Chiu R,O'Malley DP,et al.Chronic myelomonocytic leukemia:The role of bone marrow biopsy immunohistology[J].Mod Pathol,2006,19(12):1536-1545
[10]Della PM,Malcovati L,Boveri E,et al.Clinical relevance of bone marrow fibrosis and CD34-positive cell clusters in primary myelodysplastic syndromes[J].J Clin Oncol,2009,27(5):754-762