120例浆细胞肿瘤累及骨髓的病理诊断分析  

Pathological diagnosis analysis of 120 cases of plasma cell neoplasms involving bone marrow

作　　者：张益清 ZHANG Yiqing(Department of Pathology,Beijing Hightrust Diagnostics,Beijing,100176,China)

机构地区：[1]北京海思特医学检验实验室病理科,北京100176

出　　处：《当代医学》2024年第24期132-135,共4页Contemporary Medicine

摘　　要：目的探讨浆细胞肿瘤(plasma cell neoplasms,PCN)累及骨髓的临床病理特征、免疫表型、诊断及鉴别诊断。方法回顾性分析2021年1月至2022年1月北京海思特医学检验实验室收检的120例PCN累及骨髓患者的临床资料,对120例PCN累及骨髓患者进行骨髓活检,分析其异常细胞形态、免疫组织化学特征、流式细胞学免疫分型。结果120例患者中,男67例,女53例。PCN累及骨髓的异常细胞比例为0.5%~99.0%,以间质性骨髓浸润为主,占比47.5%,结节性骨髓浸润占比33.3%,弥漫性骨髓浸润占比19.2%,伴有继发性骨髓纤维化占比52.5%。120例均表达浆细胞相关抗原,表达CD38、CD138、MUM-1占比100.0%,表达CD56占比68.3%,表达胞浆型单克隆Ig轻链Lambda占比70.8%,表达胞浆型单克隆Ig轻链Kappa占比27.5%,未见Ig轻链明显表达占比1.7%。成熟浆细胞形态亚型占比87.5%,母细胞性浆细胞形态亚型占比6.7%,淋巴样浆细胞形态亚型占比5.8%,淋巴样浆细胞形态亚型均表达PAX-5,母细胞性浆细胞形态亚型Ki67增殖指数为30%~50%,非母细胞性浆细胞形态亚型Ki67增殖指数为5%~10%。120例行流式细胞学免疫分型,均可见单克隆浆细胞,异常细胞约占有核细胞的0.1%~30.0%。结论PCN是一种常见的血液肿瘤,累及骨髓的异常浆细胞分布不均,成熟浆细胞形态亚型为主,早期骨髓间质浸润易漏诊,诊断需结合骨髓活检加免疫组化及相关临床检测综合考虑。Objective To investigate the clinicopathological characteristics,immunophenotype,diagnosis and differential diagnosis of plasma cell neoplasms(PCN)involving bone marrow.Methods The clinical data of 120 patients with PCN involving bone marrow admitted to from January 2021 to Beijing Hightrust Diagnostics from January 2021 to January 2022 were retrospectively analyzed,bone marrow biopsies were performed in 120 patients with PCN involving bone marrow,abnormal cell morphology,immunohistochemical characteristics and flow cytometry immunotyping were analyzed.Results Among the 120 patients,there were 67 males and 53 females.The proportion of abnormal cells involved in PCN involving bone marrow was 0.5%-99.0%,mainly interstitial bone marrow infiltration,accounted for 47.5%,nodular bone marrow infiltration accounted for 33.3%,diffuse bone marrow infiltration accounted for 19.2%,accompanied by secondary bone marrow fibrosis accounted for 52.5%.All 120 cases expressed plasma cell associated antigen,expressed CD38,CD138,MUM-1 accounted for 100.0%;expressed CD56 accounted for 68.3%;expressed cytoplasmic monoclonal Ig light chain lambda accounted for 70.8%;expressed cytoplasmic monoclonal Ig light chain Kappa accounted for 27.5%;no significant expression of Ig light chains accounted for 1.7%.The morphological subtypes of mature plasma cell accounted for 87.5%,that of blastic plasma cell accounted for 6.7%,that of lymphoid plasma cell accounted for 5.8%,that of lymphoid plasma cell all expressed PAX-5,and the proliferation index of Ki67 of blastic plasma cell was 30%-50%,and the proliferation index of Ki67 of non blastic plasma cell was 5%-10%.All 120 cases of flow cytometric immunophenotyping showed monoclonal plasma cells,and abnormal cells accounted for 0.1%-30.0%of nuclear cells.Conclusion PCN is a common blood tumor,abnormal plasma cell involved in bone marrow are unevenly distributed,and mature plasma cell are mainly morphologically subtypes,and early bone marrow interstitial infiltration is easy to be missed,the diagnosi

关 键 词：浆细胞肿瘤 骨髓活检 免疫组化 流式细胞学 

分 类 号：R73[医药卫生—肿瘤]