髓系/NK前体细胞急性白血病1例的诊断分析  

Laboratory diagnosis of myeloid/nature killer cell precursor acute leukemia: one case report

作　　者：王建宁[1] 包红雨[1] 孟庆奇[1] 宋敏[1] 张柳波[1] 候艳秋[1] 蒋苏豫[1] 傅行财[1] 

机构地区：[1]南京医科大学第二附属医院血液科,南京210011

出　　处：《临床肿瘤学杂志》2014年第3期258-262,共5页Chinese Clinical Oncology

摘　　要：目的分析1例髓系/NK前体细胞急性白血病(M/NKPAL)的诊断过程,提高对M/NKPAL的认识。方法对1例M/NKPAL采用细胞涂片染色、细胞化学染色方法和流式细胞术进行细胞形态学和免疫表型分析,并应用细胞遗传学和PCR技术进行染色体核型分析及T细胞受体、白血病融合基因的检测,同时结合相关文献进行分析。结果骨髓原始细胞为90.4%,绝大部分白血病细胞形态学类似急性淋巴细胞白血病L2型,过氧化物酶染色阴性,偶见Auer小体。免疫表型为CD34、HLA-DR、CD33、CD7、CD56、CD38阳性和cyCD3弱表达,而cyMPO、CD3、CD4等阴性。存在染色体核型异常,未检测到克隆性T细胞受体基因重排和白血病相关的融合基因。结论 M/NKPAL临床少见,诊断复杂,仅依据形态学难以诊断,应注意与伴有髓系抗原表达的T淋巴细胞白血病、急性髓细胞白血病微分化型、T/髓系混合表型急性白血病和母细胞性NK细胞白血病/淋巴瘤等相鉴别。Objective To analyze the diagnostic process of a rare case diagnosed of myeloid/nature killer cell precursor acute leukemia（ M/NKPAL） and to improve the recognition of M/NKPAL. Methods Cell morphology was analyzed by marrow smear and re-lated cell chemical staining. Immunophenotyping of blast cells was performed by flow cytometry. Cytogenetics technique was used for karyotype analysis. PCR was applied for detection of T-cell recepter gene rearrangement or fusion gene associated with leukemia. The related articles were reviewed. Results With regard to morphology, most of leukemic cells demonstrated that 90.4% blasts in the bone marrow were generally L2-shaped with negative reactivity of myeloperoxidase staining and Auer.s rods were occasionally found. Expres-sion of CD34, HLA-DR,CD33,CD7,CD56,CD38 and cyCD3（ dim） ,but no other markers including cyMPO,CD3 and CD4 were ob-served. Cytogenetics examination revealed abnormal karyotype. Clonal T-cell recepter gene rearrangement and fusion gene were not de-tected. Conclusion M/NKPAL is considered extremely rare and diagnosis is difficult depending merely on the morphology. It is im-portant to be distinguished from T-cell acute lymphoblastic leukemia with expression of myeloid-antigen, acute myeloid leukemia with minimal differentiation, mixed-phenotype acute leukemia with T/myeloid lineage and blastic NK cell leukemia/lymphoma.

关 键 词：急性白血病 髓系 NK细胞 免疫表型 T细胞受体基因 

分 类 号：R733.71[医药卫生—肿瘤]