儿童恶性肿瘤并发骨髓坏死2例报道及文献复习  

Malignant tumor complicated with bone marrow necrosis in children:a report of 2 cases with literature review

作　　者：王李慧 王真[1] 王欢[2] 李红[1] 蒋慧[1] 邵静波[1] WANG Li-hui;WANG Zhen;WANG Huan;LI Hong;JIANG Hui;SHAO Jing-bo(Department of Hematology,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200040,China;Department of Laboratory Medicine,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200040,China)

机构地区：[1]上海市儿童医院/上海交通大学附属儿童医院血液肿瘤科,上海200040 [2]上海市儿童医院/上海交通大学附属儿童医院检验科,上海200040

出　　处：《上海交通大学学报（医学版）》2021年第10期1401-1404,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科学技术委员会科研计划项目(18ZR1431200);上海申康医院发展中心-临床诊疗技术示范应用的规范化管理研究项目(SHDC2202010)。

摘　　要：病例1,男,6岁,2020年4月因“发现左阴囊无痛性肿物1年余,肿物增大16 d”就诊。睾丸肿瘤切除,病理检查提示髓系肉瘤,家属拒绝化学治疗(化疗)。术后3个月出现发热、贫血,骨髓涂片检查提示骨髓坏死(bone marrow necrosis,BMN),抗感染治疗1周后复查骨髓涂片见肿瘤细胞,骨髓活组织检查考虑为髓系肉瘤骨髓转移,予以化疗后缓解。病例2,女,11岁,2012年12月因“乏力、纳差1个月,发热3 d”就诊,腹部CT示后腹膜恶性肿瘤,多部位骨累及,骨髓涂片检查提示BMN,确诊为神经母细胞瘤,化疗后缓解。2020年5月,因“骨痛伴发热3 d”入院,骨髓涂片检查提示肿瘤复发,予抗感染治疗及化疗后,复查骨髓提示BMN。积极抗感染治疗后,骨髓提示肿瘤缓解,并行造血干细胞移植,现为移植后随访。BMN病因复杂,恶性肿瘤是常见的病因。针对肿瘤细胞,骨髓活组织检查较骨髓涂片检查可更有效地确诊疾病。对导致BMN的原发病进行及时诊断和积极治疗能够提高预后。Case 1 is a 6-year-old boy,who was admitted to hospital in April,2020 due to "the left scrotal painless tumor found more than 1 year ago,with enlargement for16 d'.The testicular tumor was removed by orchiectomy,and pathological examination suggested myeloid sarcoma,but the family members refused chemotherapy.Three months after the orchiectomy,the patient had fever and anemia.The bone marrow smears showed bone marrow necrosis.After 1 week of anti-infection treatment,bone marrow smears showed tumor cells while bone marrow biopsies suggested bone marrow metastasis of myeloid sarcoma.The patient had bone marrow remission after chemotherapy.Case 2 is a 11-year-old girl.She was admitted for "weakness,poor appetite for 1 month,fever for 3 d􀆳in December 2012.Abdominal CT showed retroperitoneal malignant tumor with multiple bone metastasis.Bone marrow smear showed bone marrow necrosis.The diagnosis was neuroblastoma,and the patient was in remission after treatment.In May 2020,she was admitted for "bone pain with fever for 3 d'.Bone marrow smear showed tumor recurrence.Anti-infection and chemotherapy were given,and bone marrow reexamination showed bone marrow necrosis.After aggressive anti-infection treatment,the bone marrow showed remission.She had hematopoietic stem cell transplantation,and now is on a post-transplant follow-up.The cause of bone marrow necrosis is complicated and malignant tumor is a common cause.For tumor cells,bone marrow biopsy can diagnose the disease more effectively than bone marrow smears.Prompt diagnosis and active treatment of the primary disease,which can cause bone marrow necrosis,can improve the prognosis.

关 键 词：骨髓坏死 骨髓转移 骨髓活组织检查 恶性肿瘤 

分 类 号：R725.5[医药卫生—儿科]