非造血组织肿瘤骨髓转移的诊断及肿瘤细胞形态学特点研究
发布时间：2018-10-22 18:40
【摘要】：研究目的：本研究通过回顾性分析骨髓转移性肿瘤的临床特点、血液学特征(包括血常规,生化,肿瘤标志物)及观察不同原发病灶的肿瘤细胞形态特点,探讨骨髓转移性肿瘤的诊断要点及寻找原发肿瘤来源,从而提高对该疾病的诊断认识。研究方法：选择我院2009年1月-2014年10月经骨髓细胞学及病理组织学检查确诊的77例骨髓转移性肿瘤患者,对其临床特征及实验室检查(血常规、血生化、肿瘤标志物、血象及骨髓象,影像学检查)进行回顾性分析。结果：1.50岁以上的中老年患者占64.9%。临床上以骨痛(65%)、贫血伴血小板减低(63.6%)及幼红、幼粒细胞血症(61%)最常见。2.44例原发肿瘤分布：前列腺癌12例(15.6%),肺癌11例(14.3%),胃癌9例(11.7%),乳腺癌8例(10.4%),神经母细胞瘤4例(5.2%)；原发灶不明33例(42.9%)。3.血液学检查发现血沉(ESR),血清碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)升高明显,血清白蛋白(ALB)减低。4.骨髓细胞学检查发现不同原发病灶的骨髓转移性肿瘤细胞形态特点不同,共性特点是涂片尾部及边缘可见数量不等的散在或成团、成簇分布的肿瘤细胞,大小不一、数量不等、分布不均、形态异常,可见多核巨癌细胞(“合胞体”样)及退化癌细胞。5.部分患者X线,腰椎CT检查发现骨质破坏,异常征象；骨扫描发现全身骨多发放射性浓聚灶；核磁共振成像检查发现骨质破坏,骨髓腔内出现多发异常信号影；提示转移癌可能性大。结论：1.骨痛、贫血、发热、消瘦是骨髓转移性肿瘤最常见的临床症状：2.外周血象中出现幼红幼粒细胞是骨髓转移性肿瘤较为特征性的改变；3.骨髓细胞学检查可诊断非造血组织恶性肿瘤骨髓转移,但较难推测原发肿瘤的来源,对神经母细胞瘤(NB)、小细胞肺癌、胃癌(印戒细胞癌)的诊断具有参考意义。4.血清碱性磷酸酶(ALP),乳酸脱氢酶(LDH),癌胚抗原(CEA)异常升高,建议行骨髓穿刺,可及早判断是否存在非造血组织恶性肿瘤骨髓浸润,同时也是初筛,监测及预后判断的良好指标；5.骨穿时发生干抽或稀释,提示骨髓发生病理性改变；骨髓抽吸-活检双标本一步法取材,辅以免疫组化,不仅提高检测的阳性率,还可以明确原发肿瘤来源；6.骨髓转移性肿瘤早期诊断应注重癌症病史-症状体征-实验室检查的综合分析。
[Abstract]:Objective: to retrospectively analyze the clinical features, hematological features (including blood routine, biochemical, tumor markers) of bone marrow metastatic tumors and observe the morphological characteristics of tumor cells in different primary tumors. To explore the main points of diagnosis of bone marrow metastatic tumor and to find the origin of primary tumor, so as to improve the diagnosis of the disease. Methods: from January 2009 to October 2014, 77 patients with bone marrow metastatic tumor diagnosed by bone marrow cytology and histopathology were selected, and their clinical features and laboratory examinations (blood routine examination, blood biochemistry, tumor markers) were analyzed. The blood and bone marrow images were analyzed retrospectively. Results: 1. 64.9% of the patients were over 50 years old. Osteodynia (65%), anemia with thrombocytopenia (63.6%) and juvenile redness (61.1%) were the most common. 2.44 cases of primary tumor were as follows: prostate cancer 12 cases (15.6%), lung cancer 11 cases (14.3%), gastric cancer 9 cases (11.7%), breast cancer 8 cases (10.4%), neuroblastoma 4 cases (5.2%). 33 cases (42.9%) with unknown primary focus. Hematologic examination showed that serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA) increased significantly and serum albumin (ALB) decreased 4. 4% in erythrocyte sedimentation rate (ESR),). Bone marrow cytological examination showed that the morphologic characteristics of bone marrow metastatic tumor cells were different in different primary foci. The common features were that there were different numbers of scattered or clustered tumor cells in the tail and edge of the smear, and the size and quantity of the tumor cells in clusters were different. Uneven distribution, abnormal morphology, multinucleated giant cancer cells ("syncytial" like) and degenerative cancer cells. 5. In some patients, X-ray, lumbar CT examination found bone destruction, abnormal signs; bone scan found multiple radionuclide foci in the whole body; MRI found bone destruction, multiple abnormal signal in the medullary cavity. It suggests that metastatic cancer is more likely. Conclusion 1. Bone pain, anemia, fever, and wasting are the most common clinical symptoms of bone marrow metastases: 2. The appearance of juvenile red granulocyte in peripheral blood was the characteristic change of bone marrow metastatic tumor. Bone marrow cytology can diagnose bone marrow metastasis of non-hematopoietic malignant tumor, but it is difficult to speculate the origin of primary tumor. It has reference significance for the diagnosis of (NB), small cell lung cancer and gastric cancer (signet ring cell carcinoma) of neuroblastoma. 4. Serum alkaline phosphatase (ALP),) lactate dehydrogenase (LDH),) carcinoembryonic antigen (CEA) was increased abnormally. It was suggested that bone marrow aspiration should be performed early to determine the presence of bone marrow infiltration in non-hematopoietic malignancies, and it was also a good index for screening, monitoring and predicting prognosis. 5. The pathological changes of bone marrow occurred during bone puncture, which indicated that bone marrow aspiration and biopsy could not only increase the positive rate of examination, but also identify the origin of primary tumor. 6. Early diagnosis of bone marrow metastases should focus on comprehensive analysis of cancer history, symptoms and signs, and laboratory examination.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R730.43
本文编号：2287992
[Abstract]:Objective: to retrospectively analyze the clinical features, hematological features (including blood routine, biochemical, tumor markers) of bone marrow metastatic tumors and observe the morphological characteristics of tumor cells in different primary tumors. To explore the main points of diagnosis of bone marrow metastatic tumor and to find the origin of primary tumor, so as to improve the diagnosis of the disease. Methods: from January 2009 to October 2014, 77 patients with bone marrow metastatic tumor diagnosed by bone marrow cytology and histopathology were selected, and their clinical features and laboratory examinations (blood routine examination, blood biochemistry, tumor markers) were analyzed. The blood and bone marrow images were analyzed retrospectively. Results: 1. 64.9% of the patients were over 50 years old. Osteodynia (65%), anemia with thrombocytopenia (63.6%) and juvenile redness (61.1%) were the most common. 2.44 cases of primary tumor were as follows: prostate cancer 12 cases (15.6%), lung cancer 11 cases (14.3%), gastric cancer 9 cases (11.7%), breast cancer 8 cases (10.4%), neuroblastoma 4 cases (5.2%). 33 cases (42.9%) with unknown primary focus. Hematologic examination showed that serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA) increased significantly and serum albumin (ALB) decreased 4. 4% in erythrocyte sedimentation rate (ESR),). Bone marrow cytological examination showed that the morphologic characteristics of bone marrow metastatic tumor cells were different in different primary foci. The common features were that there were different numbers of scattered or clustered tumor cells in the tail and edge of the smear, and the size and quantity of the tumor cells in clusters were different. Uneven distribution, abnormal morphology, multinucleated giant cancer cells ("syncytial" like) and degenerative cancer cells. 5. In some patients, X-ray, lumbar CT examination found bone destruction, abnormal signs; bone scan found multiple radionuclide foci in the whole body; MRI found bone destruction, multiple abnormal signal in the medullary cavity. It suggests that metastatic cancer is more likely. Conclusion 1. Bone pain, anemia, fever, and wasting are the most common clinical symptoms of bone marrow metastases: 2. The appearance of juvenile red granulocyte in peripheral blood was the characteristic change of bone marrow metastatic tumor. Bone marrow cytology can diagnose bone marrow metastasis of non-hematopoietic malignant tumor, but it is difficult to speculate the origin of primary tumor. It has reference significance for the diagnosis of (NB), small cell lung cancer and gastric cancer (signet ring cell carcinoma) of neuroblastoma. 4. Serum alkaline phosphatase (ALP),) lactate dehydrogenase (LDH),) carcinoembryonic antigen (CEA) was increased abnormally. It was suggested that bone marrow aspiration should be performed early to determine the presence of bone marrow infiltration in non-hematopoietic malignancies, and it was also a good index for screening, monitoring and predicting prognosis. 5. The pathological changes of bone marrow occurred during bone puncture, which indicated that bone marrow aspiration and biopsy could not only increase the positive rate of examination, but also identify the origin of primary tumor. 6. Early diagnosis of bone marrow metastases should focus on comprehensive analysis of cancer history, symptoms and signs, and laboratory examination.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R730.43
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