脾髓外造血伴巨型脾肿大2例病理形态学观察  

Pathological morphology of splenic extramedullary hematopoiesis with megalosplenia

作　　者：魏建华[1] 

机构地区：[1]湖南师范大学附属湘东医院病理科,湖南醴陵412200

出　　处：《诊断病理学杂志》2010年第6期427-430,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨脾髓外造血(EMH)的临床病理形态学特点、诊断与鉴别诊断。方法通过光镜和免疫组化对2例脾髓外造血进行临床病理分析并结合文献复习。结果 2例脾髓外造血患者为中老年,临床表现脾肿大(巨脾),起病隐匿。脾红髓出现3种造血细胞:巨核细胞、红细胞前体和粒细胞前体,其中以巨核细胞增生显著,并具有不典型核。免疫组化:2例均CD61、CD235a和MPO(+),CD68、CD3和CD20(-)。结论脾髓外造血是骨髓增生性疾病特有的表现,好发于中老年人,形态学特征为红髓出现3种造血细胞。免疫组化CD61、CD235a和MPO(+)对诊断与鉴别诊断有重要价值。Objective To study the clinicopathological characteristics,diagnosis,differential diagnosis of splenic extramedullary hematopoiesis（EMH）.Method Clinical manifestations,pathological features,immunohistochemical findings were analyzed in 2 cases with review of the literatures.Results Two cases all occurred in middle-aged and elderly adult,and the clinical manifestation was splenomegaly and occult onset.Splenic pulp cords presented with immature cells of the erythroid and myeloid cell lines and megakaryocytes.Megakaryocytes were readily recognized by their large size,and multilobed nuclei.Immunohistochemical stains showed that immature cells were positive for CD61,CD235a and MPO,but negative for CD3,CD20 and CD68.Conclusions Splenic extramedullary hematopoiesis variant is a characterized feature of myeloproliferative disorders.The splenic EMH often occurs in middle-aged and aged patients.Microscopically,splenic EMH is characterized with immature cells of the erythroid and myeloid cell lines and megakaryocytes.Immunohistochemically,the expression of CD61,CD235a and MPO play an important role in diagnosis and differential diagnosis.

关 键 词：脾髓外造血 巨脾 病理 诊断 CD61 CD235a MPO 

分 类 号：R551.1[医药卫生—血液循环系统疾病]