摘要
目的探讨慢性粒细胞白血病(CML)骨髓病理特征、免疫表型、诊断及鉴别诊断。方法回顾性分析68例CML患者骨髓活检、网银染色、免疫组织化学、BCR/ABL1融合基因检查结果并复习相关文献。结果男38例,女30例。68例骨髓活检造血组织容量在60%~90%之间,86.8%(59/68)表现为粒系及巨核两系明显增生,属于CML慢性期(粒系及巨核细胞双增生型)。11.8%(8/68)表现为粒系明显增生,巨核细胞增生不明显,属于CML慢性期(粒系单增生型)。1.5%(1/68)表现为原始粒细胞明显增生,属于CML急变期。免疫组织化学证实粒系、红系及巨核三系分布情况,RT-PCR检查BCR/ABL1融合基因,100%(68/68)p210融合基因阳性。结论CML在骨髓活检病理中以慢性期常见,鉴于CML慢性期与PMF较难鉴别,诊断需结合临床表现、病理组织学特点、免疫组化及BCR/ABL1融合基因检测综合诊断。
Objective To explore the pathological features,immunophenotypes,diagnosis,and differential diagnosis of CML in bone marrow.Methods Retrospective analysis of bone marrow biopsy,gomori,immunohistochemistry,and BCR/ABL1 fusion gene detection results of 68 patients with CML,and review of relevant literature.Results There are 38 males and 30 females.68 cases of bone marrow biopsy showed a hematopoietic tissue volume between 60-90%,and 86.8%(59/68)showed significant proliferation of both granulocytes and megakaryocytes,belonging to the chronic phase of CML(double proliferation type of granulocytes and megakaryocytes).11.8%(8/68)showed significant proliferation of granulocytes,with no significant proliferation of megakaryocytes,belonging to the chronic phase of CML(granulocytes monoproliferative type).1.5%(1/68)showed significant proliferation of primitive granulocytes,belonging to the acute phase of CML.Immunohistochemistry confirmed the distribution of granulosa,erythroid,and megakaryocyte lineages,RT-PCR examination showed that the BCR/ABL1 fusion gene was 100%(68/68)positive for p210 fusion gene.Conclusion CML is commonly seen in the chronic phase of bone marrow biopsy pathology.Considering the difficulty in distinguishing CML from PMF in the chronic phase,the diagnosis needs to be combined with clinical manifestations,histopathological characteristics,immunohistochemistry,and BCR/ABL1 fusion gene testing for comprehensive diagnosis.
作者
张益清
ZHANG Yi-qing(Department of Pathology,Beijing Hightrust Diagnostics,Beijing 100176,China)
出处
《诊断病理学杂志》
2024年第8期762-764,783,共4页
Chinese Journal of Diagnostic Pathology
