60例滤泡淋巴瘤骨髓肿瘤细胞的形态学分析
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摘要
目的:对滤泡淋巴瘤骨髓的淋巴瘤细胞进行形态学分析总结形态特点,为骨髓病理医生对滤泡淋巴瘤骨髓累及诊断提供一定的参考依据。方法:回顾性分析2013年至2018年共565例经淋巴结活检病理确诊滤泡淋巴瘤患者,并挑选其中60例有骨髓侵犯的患者,对其骨髓涂片进行观察,根据其肿瘤细胞的形态特点进行分析归类总结,找出共同特点。结果:对本组60例滤泡淋巴瘤骨髓涂片根据肿瘤细胞形态特点共分为五种类型,包括小无裂细胞型(38. 3%)、小裂细胞型(31. 7%)、幼淋巴细胞型(5. 0%)、母细胞化型(5. 0%)以及滤泡转大B细胞型(20. 0%)。结论:滤泡淋巴瘤累及骨髓病例可通过观察肿瘤细胞的细胞形态分为五种类型,其中以小无裂细胞和小裂细胞最为常见(70. 0%),每种类型肿瘤细胞具有明显的特点,具有重要的病理和临床指导意义。
Objective: Morphological analysis of the lymphoma cells in the bone marrow of follicular lymphoma was carried out to summarize the morphological characteristics,which provided certain references for the pathologist of bone marrow of follicular lymphoma. Methods: From 2013 to 2018 clinical data were retrospectively analyzed in 565 cases of patients with follicular lymphoma with lymph node biopsy pathology and select 60 cases of patients with bone marrow involvement were selected,then the bone marrow smears were observed. According to its morphological characteristics of tumor cells,the common characteristic was found out. Results: This group of 60 cases of follicular lymphoma tumor cells in bone marrow smear morphological characteristics will be divided into five types,including small non-split lymphocyte type( 38. 3%),small split lymphocyte type( 31. 7%),prolymphocytic type( 5. 0%),primordial lymphocyte type( 5. 0%),and large B-lymphocyte type( 20. 0%). Conclusion: Cases of follicular lymphoma involving the marrow can be divided into five types through the observation of tumor cells form,among them small non-split lymphocyte and small split lymphocyte accounts for the most common( 70. 0%). There are obvious characteristics in each type of the tumor cells,and important pathologic and clinical significance.
Objective: Morphological analysis of the lymphoma cells in the bone marrow of follicular lymphoma was carried out to summarize the morphological characteristics,which provided certain references for the pathologist of bone marrow of follicular lymphoma. Methods: From 2013 to 2018 clinical data were retrospectively analyzed in 565 cases of patients with follicular lymphoma with lymph node biopsy pathology and select 60 cases of patients with bone marrow involvement were selected,then the bone marrow smears were observed. According to its morphological characteristics of tumor cells,the common characteristic was found out. Results: This group of 60 cases of follicular lymphoma tumor cells in bone marrow smear morphological characteristics will be divided into five types,including small non-split lymphocyte type( 38. 3%),small split lymphocyte type( 31. 7%),prolymphocytic type( 5. 0%),primordial lymphocyte type( 5. 0%),and large B-lymphocyte type( 20. 0%). Conclusion: Cases of follicular lymphoma involving the marrow can be divided into five types through the observation of tumor cells form,among them small non-split lymphocyte and small split lymphocyte accounts for the most common( 70. 0%). There are obvious characteristics in each type of the tumor cells,and important pathologic and clinical significance.
引文
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[13]Silvana Novelli,Javier Briones,Jorge Sierra.Epidemiology of lymphoid malignancies:Last decade update[J].Springer Plus,2013,2:70
[14]Chen RZ,Xu W,Li JY.Progress in the treatment of follicular lymphoma:Report from the 56th american society of hematology annual meeting[J].Journal of Leukemia&Lymphoma,2015,24(1):6-8.[陈睿泽,徐卫,李建勇.滤泡淋巴瘤治疗进展:第56届美国血液学会年会报道[J].白血病·淋巴瘤,2015,24(1):6-8.]
[15]Arnold S,Freedman MD.Follicular lymphoma:2014 update on diagnosis and management[J].American Journal of Hematology,2014,89(4):429-436.
[16]Li SL,Zhang TT,Gao DL,et al.Correlation of bone marrow microenvironment and development and development of follicular lymphoma[J].Chinese Journal of Clinical and Experimental Pathology,2015,31(11):1275-1277.[李少玲,张甜甜,高大林,等.骨髓微环境和滤泡淋巴瘤发生、发展的相关性研究[J].临床与实验病理学杂志,2015,31(11):1275-1277.]
[17]Montoto S,Fitzgibbon J.Transformation of Indolent B-cell lymphomas[J].Clin Oncol,2011,29:1827-1834.
[18]Ye XJ,Qian WB.Prognosis and stratified treatment strategies for follicular lymphoma[J].Chinese Journal of Practical Internal Medicine,2015,35(2):99-101.[叶琇锦,钱文斌.滤泡性淋巴瘤预后和分层治疗策略[J].中国实用内科杂志,2015,35(2):99-101.]
[19]Wang L,Yan B,Yu Y,et al.The effect of strict stage at the initial diagnosis on the prognosis of patients with follicular cell lymphoma[J].Journal of Experimental Hematology,2017,25(1):126-132.[王路,闫蓓,于泳,等.初诊时的严格分期对滤泡细胞淋巴瘤患者预后的影响[J].中国实验血液学杂志,2017,25(1):126-132.]
[20]Michael Herold,Christian W,Scholz,et al.Long-term followup of rituximab plus first-line mitoxantrone,chlorambucil,prednisolone and interferon-alpha as maintenance therapy in follicular lymphoma[J].Cancer Res Clin Oncol,2015,141:1689-1695.
[21]Liu Jin.Analysis of prognostic features of follicular lymphoma[J].Chinese Community Doctors,2016,32(4):32-34.[刘瑾.滤泡性淋巴瘤预后特征分析[J].中国社区医师,2016,32(4):32-34.]
[22]Yang SL.Analysis of clinical features and prognostic factors of follicular lymphoma[J].Chinese Journal of Clinical Oncology and Rehabilitation,2014,21(4):488-490.[杨尚伦.滤泡性淋巴瘤的临床特征及预后因素分析[J].中国肿瘤临床与康复,2014,21(4):488-490.]
[2]Kuruvilla J,Assouline S,Hodgson D,et al.A Canadian evidencebased guideline for the first-line treatment of follicular lymphoma:Joint consensus of the Lymphoma Canada Scientific Advisory Board[J].Clin Lymphoma Myeloma Leuk,2015,15(2):59-74.
[3]Chinese Medical Association Hematology Branch,China Anticancer Association Lymphoma Professional Committee.Chinese diagnosis and treatment guideline for follicular lymphoma(2013 version)[J].Chinese Journal of Hematology,2013,34(9):820-824.[中华医学会血液学分会,中国抗癌协会淋巴瘤专业委员会.中国滤泡性淋巴瘤诊断与治指南(2013版)[J].中华血液学杂志,2013,34(9):820-824.]
[4]Zhang W,Wang J,Wan W,et al.Clinical characteristics and prognostic factors of 59 cases of follicular lymphoma[J].Journal of Experimental Hematology,2013,21(6):1448-1453.[张巍,王晶,万伟,等.59例滤泡淋巴瘤的临床特点和预后因素分析[J].中国实验血液学杂志,2013,21(6):1448-1453.]
[5]Zelenetz AD,Abramson JS,Advani RH,et al.Non-Hodgkin's lymphomas[J].Natl Compr Canc Netw,2011,9(5):484-560.
[6]Sarah C Rutherford,Valery Li,Paola Ghione,et al.Bone marrow biopsies do not impact response assessment for follicular lymphoma patients treated on clinical trials[J].British Journal of Haematology,2017,179(2):242-245.
[7]Wang WJ,Zhao J,He PC,et al.Characteristics and diagnostic values of bone marrow cell morphology and immunophenotyping in lymphoma cell leukemia[J].Journal of Experimental Hematology,2018,26(2):459-463.[王雯娟,赵娟,贺鹏程,等.淋巴瘤细胞白血病骨髓细胞形态学和免疫分型的特点及其在诊断中的价值[J].中国实验血液学杂志,2018,26(2):459-463.]
[8]Che Yiqun,Liu Peng,Wang Yue,et al.BCL-2/Ig H expression in minimal bone marrow in ltration by follicular lymphoma cells[J].Molecular Medicine Reports,2012,5:383-387.
[9]Zhao J,Yuan TT,Yang XL,et al.Significance of simultaneous analysis of bone marrow smear and bone marrow biopsy in the diagnosis of lymphoma[J].Journal of Experimental Hematology,2017,25(3):777-780.[赵娟,袁婷婷,杨小亮,等.骨髓涂片及骨髓活检切片同步分析在淋巴瘤诊断中的意义[J].中国实验血液学杂志,2017,25(3):777-780.]
[10]Katsuyoshi Takata,Tomoko Miyata-Takata,Yasuharu Sato,et al.Pathology of follicular lymphoma[J].Clin Exp Hematop,2014,54(1):3-9.
[11]Zhao DongLu,Ma Jun.Progress of follicular lymphoma[J].Journal of Leukemia&Lymphoma,2018,27(1):16-19.[赵东陆,马军.滤泡性淋巴瘤研究进展[J].白血病·淋巴瘤,2018,27(1):16-19.]
[12]Kang HY,Wang Y,Jin SY,et al.Detection of bone marrow morphology combined with serum tumor markers in the diagnosis and prognosis of lymphoma[J].Journal of Experimental Hematology,2015,23(2):416-419.[康慧媛,汪洋,金淑媛,等.骨髓形态联合血清肿瘤标志物检测对淋巴瘤的诊断及预后意义[J].中国实验血液学杂志,2015,23(2):416-419.]
[13]Silvana Novelli,Javier Briones,Jorge Sierra.Epidemiology of lymphoid malignancies:Last decade update[J].Springer Plus,2013,2:70
[14]Chen RZ,Xu W,Li JY.Progress in the treatment of follicular lymphoma:Report from the 56th american society of hematology annual meeting[J].Journal of Leukemia&Lymphoma,2015,24(1):6-8.[陈睿泽,徐卫,李建勇.滤泡淋巴瘤治疗进展:第56届美国血液学会年会报道[J].白血病·淋巴瘤,2015,24(1):6-8.]
[15]Arnold S,Freedman MD.Follicular lymphoma:2014 update on diagnosis and management[J].American Journal of Hematology,2014,89(4):429-436.
[16]Li SL,Zhang TT,Gao DL,et al.Correlation of bone marrow microenvironment and development and development of follicular lymphoma[J].Chinese Journal of Clinical and Experimental Pathology,2015,31(11):1275-1277.[李少玲,张甜甜,高大林,等.骨髓微环境和滤泡淋巴瘤发生、发展的相关性研究[J].临床与实验病理学杂志,2015,31(11):1275-1277.]
[17]Montoto S,Fitzgibbon J.Transformation of Indolent B-cell lymphomas[J].Clin Oncol,2011,29:1827-1834.
[18]Ye XJ,Qian WB.Prognosis and stratified treatment strategies for follicular lymphoma[J].Chinese Journal of Practical Internal Medicine,2015,35(2):99-101.[叶琇锦,钱文斌.滤泡性淋巴瘤预后和分层治疗策略[J].中国实用内科杂志,2015,35(2):99-101.]
[19]Wang L,Yan B,Yu Y,et al.The effect of strict stage at the initial diagnosis on the prognosis of patients with follicular cell lymphoma[J].Journal of Experimental Hematology,2017,25(1):126-132.[王路,闫蓓,于泳,等.初诊时的严格分期对滤泡细胞淋巴瘤患者预后的影响[J].中国实验血液学杂志,2017,25(1):126-132.]
[20]Michael Herold,Christian W,Scholz,et al.Long-term followup of rituximab plus first-line mitoxantrone,chlorambucil,prednisolone and interferon-alpha as maintenance therapy in follicular lymphoma[J].Cancer Res Clin Oncol,2015,141:1689-1695.
[21]Liu Jin.Analysis of prognostic features of follicular lymphoma[J].Chinese Community Doctors,2016,32(4):32-34.[刘瑾.滤泡性淋巴瘤预后特征分析[J].中国社区医师,2016,32(4):32-34.]
[22]Yang SL.Analysis of clinical features and prognostic factors of follicular lymphoma[J].Chinese Journal of Clinical Oncology and Rehabilitation,2014,21(4):488-490.[杨尚伦.滤泡性淋巴瘤的临床特征及预后因素分析[J].中国肿瘤临床与康复,2014,21(4):488-490.]