伴有腹水形成的腹腔髓系肉瘤临床病理特征  

Clinicopathological characteristics of abdominal myeloid sarcoma with ascites formation

作　　者：丁洁 倪海雯 于慧 申龙树 唐福婷 章宜芬 DING Jie;NI Hai-wen;YU Hui;SHEN Long-shu;TANG Fu-ting;ZHANG Yi-fen(Department of Pathology,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Jiangsu Hospital of Traditional Chinese Medicine,Nɑnjinɡ210029,China;Department of Hematology,Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Jiangsu Hospital of Traditional Chinese Medicine,Nɑnjinɡ210029,China)

机构地区：[1]南京中医药大学附属医院江苏省中医院病理科,南京210029 [2]南京中医药大学附属医院江苏省中医院血液科,南京210029

出　　处：《诊断病理学杂志》2022年第1期17-20,26,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的腹腔髓系肉瘤(myeloid sarcoma,MS)伴腹水形成较为罕见,本文总结其临床病理特征、治疗及预后。方法报道江苏省中医院1例确诊的以腹水为首发症状的腹腔髓系肉瘤患者的临床资料、影像学检查、腹水细胞学、免疫组化、骨髓穿刺、治疗预后和随访结果。分别在万方数据库和PubMed检索到6篇中文和8篇英文腹腔髓系肉瘤伴腹水形成文章共14例,且均为个案报道。结果患者,女性,49岁,因“无明显诱因出现腹胀、腹痛”就诊,CT示小肠占位伴大量腹水。胸部磁共振示:两肺及前纵隔多发实性小结节,转移不除外。腹水细胞涂片光镜可见大量弥散分布的圆形、卵圆形肿瘤细胞,大小相对一致;细胞质少,嗜碱性;部分细胞可见核沟和小核仁,核分裂象少见;背景中见少量前体嗜酸性粒细胞。细胞蜡块免疫组化示肿瘤表达弥漫MPO、CD34、CD68。患者后续行骨髓穿刺示原始粒细胞占21.6%,遂行联合化疗,腹水消退,症状明显改善。回顾中英文文献并结合本病例发现,腹腔髓系肉瘤伴腹水形成极易导致临床误诊,腹水细胞学结合细胞蜡块免疫组化,能进一步病理确诊。多数髓系肉瘤伴腹水形成伴有急性髓系白血病(acute myeloid leukemia,AML),针对粒细胞肉瘤化疗通常有效,然而整体预后较差。结论腹腔髓系肉瘤通常伴腹水形成且比较罕见,对于既往史无急性髓系白血病患者,临床和影像容易误诊。腹水细胞学结合细胞蜡块免疫组化能够作出准确的病理诊断。Objective The primary myeloid sarcoma(myeloid sarcoma,MS)of the abdominal cavity with ascites formation is rare.This article summarized its clinicopathological characteristics,treatment and prognosis.Methods The clinical data,imaging examination,ascites cytology,immunohistochemistry,bone marrow puncture,treatment prognosis and follow⁃up results of a patient with a confirmed abdominal myeloid sarcoma with ascites as the first symptom in Jiangsu Provincial Hospital of Traditional Chinese Medicine were reported.A total of 14 cases of abdominal myeloid sarcoma with ascites formation were retrieved from Wanfang Medical Database and PubMed respectively in 6 Chinese and 8 English articles,all of which were case reports.Results A 49⁃year⁃old female patient presented with abdominal distension and abdominal pain without obvious cause.CT showed small intestinal space with large amounts of ascites.Chest MRI showed that there were multiple solid nodules in both lungs and anterior mediastinum,and metastic lessions could not be excluded.Light microscopy of ascites cell smear showed a large number of diffusely distributed round and oval tumor cells,relatively uniform in size,less basophilic cytoplasm;nuclear grooves and small nucleoli were seen in some cells,and mitotic figures were rare;a small number of precursor eosinophils were seen in the background.Cell block immunohistochemistry showed that the tumor expressed diffuse MPO,CD34,and CD68.The patient’s subsequent bone marrow aspiration showed that primordial granulocyte accounted for 21.6%,and combined chemotherapy was performed.Ascites subsided and symptoms improved significantly.Reviewing the Chinese and English literature and combining our case found that the formation of abdominal myeloid sarcoma with ascites could easily lead to clinical misdiagnosis.Ascites cytology combined with cell wax immunohistochemistry could be further diagnosed pathologically.Most myeloid sarcomas with ascites formation were accompanied by acute myeloid leukemia(AML).Chemotherapy for gr

关 键 词：髓系肉瘤 粒细胞肉瘤 腹水 临床病理特征 

分 类 号：R73[医药卫生—肿瘤]