肱骨骨内髓脂肪瘤的形态学特征及与肾上腺髓脂肪瘤和正常骨髓组织的比较  

Intraosseous myelolipoma of humerus:clinicopathologic features and comparison between adrenal myelolipoma and normal bone marrow

作　　者：李剑[1] 尹为华[1] 刘远健[2] 

机构地区：[1]北京大学深圳医院病理科,广东深圳518000 [2]北京大学深圳医院放射科,广东深圳518000

出　　处：《诊断病理学杂志》2012年第5期330-333,338,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨骨内髓脂肪瘤的临床病理特征,并与肾上腺髓脂肪瘤和正常骨髓组织的形态比较。方法采用HE染色、Gomori银染及TUNEL凋亡检测方法,观察1例原发于肱骨的骨内髓脂肪瘤的组织学特点、网状纤维程度及造血细胞凋亡比率,并与4例典型的肾上腺髓脂肪瘤和8例正常骨髓组织标本比较。结果骨内髓脂肪瘤骨小梁萎缩消失;造血细胞的增生程度在不同的区域变异较大(0～50%);局部可见成熟淋巴细胞的聚集灶;间质内出现管腔扭曲的厚壁血管;网状纤维染色()。上述特征亦见于肾上腺髓脂肪瘤,而与正常骨髓相悖。造血细胞凋亡率在上述组织中无明显差异。结论骨内髓脂肪瘤罕见,骨小梁缺如是其重要特征。病变的明确诊断依赖于临床、影像学和镜下形态学的密切结合。Objective To investigate the clinicopathologic features of intraosseous myelolipoma and its morphologic similarities and/or differences with adrenal myelolipoma and normal bone marrow.Methods With the application of hematoxylin-eosin,TUNEL labeling and reticulin fibrosis staining,the histologic characteristics of a case of humeral myelolipoma as well as its reticular levels and apoptotic index were demonstrated.In the meanwhile,the links and distinctions of the intraosseous lesion with 4 cases of adrenal myelolipoma and 8 cases of normal bone marrow were illustrated.In addition,detailed literature review was performed.Results Most of the bone trabeculae in intraosseous myelolipoma were disappeared.There was a widened variation of the hematopoietic cellularity in different areas（range from 0 to 50%）.Foci of mature lymphocytes and a few thickened blood vessels with tortuous walls presented in the lesion.Furthermore,enhanced reticulin fibers（3＋） were observed.The above features could be also found in adrenal myelolipoma,whereas those usually did not show up in normal bone marrow.There were no differences of the apoptotic index among the three groups.Conclusions Intraosseous myelolipoma is an extraordinarily rare tumor and diminished bony trabeculae are a convincing indicator.There exist overt overlaps in morphologic features between intraosseous and adrenal myelolipoma,and present some nuanced distinctions from normal bone marrow.The correct diagnosis could only be drawn reassuringly on combination of clinic,imaging and pathologic studies.

关 键 词：髓脂肪瘤 肱骨 骨髓 鉴别诊断 

分 类 号：R738.1[医药卫生—肿瘤]