【摘要】：研究目的：本研究通過回顧性分析骨髓轉(zhuǎn)移性腫瘤的臨床特點、血液學(xué)特征(包括血常規(guī),生化,腫瘤標(biāo)志物)及觀察不同原發(fā)病灶的腫瘤細(xì)胞形態(tài)特點,探討骨髓轉(zhuǎn)移性腫瘤的診斷要點及尋找原發(fā)腫瘤來源,從而提高對該疾病的診斷認(rèn)識。研究方法：選擇我院2009年1月-2014年10月經(jīng)骨髓細(xì)胞學(xué)及病理組織學(xué)檢查確診的77例骨髓轉(zhuǎn)移性腫瘤患者,對其臨床特征及實驗室檢查(血常規(guī)、血生化、腫瘤標(biāo)志物、血象及骨髓象,影像學(xué)檢查)進(jìn)行回顧性分析。結(jié)果：1.50歲以上的中老年患者占64.9%。臨床上以骨痛(65%)、貧血伴血小板減低(63.6%)及幼紅、幼粒細(xì)胞血癥(61%)最常見。2.44例原發(fā)腫瘤分布：前列腺癌12例(15.6%),肺癌11例(14.3%),胃癌9例(11.7%),乳腺癌8例(10.4%),神經(jīng)母細(xì)胞瘤4例(5.2%)；原發(fā)灶不明33例(42.9%)。3.血液學(xué)檢查發(fā)現(xiàn)血沉(ESR),血清堿性磷酸酶(ALP)、乳酸脫氫酶(LDH)、癌胚抗原(CEA)升高明顯,血清白蛋白(ALB)減低。4.骨髓細(xì)胞學(xué)檢查發(fā)現(xiàn)不同原發(fā)病灶的骨髓轉(zhuǎn)移性腫瘤細(xì)胞形態(tài)特點不同,共性特點是涂片尾部及邊緣可見數(shù)量不等的散在或成團(tuán)、成簇分布的腫瘤細(xì)胞,大小不一、數(shù)量不等、分布不均、形態(tài)異常,可見多核巨癌細(xì)胞(“合胞體”樣)及退化癌細(xì)胞。5.部分患者X線,腰椎CT檢查發(fā)現(xiàn)骨質(zhì)破壞,異常征象；骨掃描發(fā)現(xiàn)全身骨多發(fā)放射性濃聚灶；核磁共振成像檢查發(fā)現(xiàn)骨質(zhì)破壞,骨髓腔內(nèi)出現(xiàn)多發(fā)異常信號影；提示轉(zhuǎn)移癌可能性大。結(jié)論：1.骨痛、貧血、發(fā)熱、消瘦是骨髓轉(zhuǎn)移性腫瘤最常見的臨床癥狀：2.外周血象中出現(xiàn)幼紅幼粒細(xì)胞是骨髓轉(zhuǎn)移性腫瘤較為特征性的改變；3.骨髓細(xì)胞學(xué)檢查可診斷非造血組織惡性腫瘤骨髓轉(zhuǎn)移,但較難推測原發(fā)腫瘤的來源,對神經(jīng)母細(xì)胞瘤(NB)、小細(xì)胞肺癌、胃癌(印戒細(xì)胞癌)的診斷具有參考意義。4.血清堿性磷酸酶(ALP),乳酸脫氫酶(LDH),癌胚抗原(CEA)異常升高,建議行骨髓穿刺,可及早判斷是否存在非造血組織惡性腫瘤骨髓浸潤,同時也是初篩,監(jiān)測及預(yù)后判斷的良好指標(biāo)；5.骨穿時發(fā)生干抽或稀釋,提示骨髓發(fā)生病理性改變；骨髓抽吸-活檢雙標(biāo)本一步法取材,輔以免疫組化,不僅提高檢測的陽性率,還可以明確原發(fā)腫瘤來源；6.骨髓轉(zhuǎn)移性腫瘤早期診斷應(yīng)注重癌癥病史-癥狀體征-實驗室檢查的綜合分析。
[Abstract]:Objective: to retrospectively analyze the clinical features, hematological features (including blood routine, biochemical, tumor markers) of bone marrow metastatic tumors and observe the morphological characteristics of tumor cells in different primary tumors. To explore the main points of diagnosis of bone marrow metastatic tumor and to find the origin of primary tumor, so as to improve the diagnosis of the disease. Methods: from January 2009 to October 2014, 77 patients with bone marrow metastatic tumor diagnosed by bone marrow cytology and histopathology were selected, and their clinical features and laboratory examinations (blood routine examination, blood biochemistry, tumor markers) were analyzed. The blood and bone marrow images were analyzed retrospectively. Results: 1. 64.9% of the patients were over 50 years old. Osteodynia (65%), anemia with thrombocytopenia (63.6%) and juvenile redness (61.1%) were the most common. 2.44 cases of primary tumor were as follows: prostate cancer 12 cases (15.6%), lung cancer 11 cases (14.3%), gastric cancer 9 cases (11.7%), breast cancer 8 cases (10.4%), neuroblastoma 4 cases (5.2%). 33 cases (42.9%) with unknown primary focus. Hematologic examination showed that serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA) increased significantly and serum albumin (ALB) decreased 4. 4% in erythrocyte sedimentation rate (ESR),). Bone marrow cytological examination showed that the morphologic characteristics of bone marrow metastatic tumor cells were different in different primary foci. The common features were that there were different numbers of scattered or clustered tumor cells in the tail and edge of the smear, and the size and quantity of the tumor cells in clusters were different. Uneven distribution, abnormal morphology, multinucleated giant cancer cells ("syncytial" like) and degenerative cancer cells. 5. In some patients, X-ray, lumbar CT examination found bone destruction, abnormal signs; bone scan found multiple radionuclide foci in the whole body; MRI found bone destruction, multiple abnormal signal in the medullary cavity. It suggests that metastatic cancer is more likely. Conclusion 1. Bone pain, anemia, fever, and wasting are the most common clinical symptoms of bone marrow metastases: 2. The appearance of juvenile red granulocyte in peripheral blood was the characteristic change of bone marrow metastatic tumor. Bone marrow cytology can diagnose bone marrow metastasis of non-hematopoietic malignant tumor, but it is difficult to speculate the origin of primary tumor. It has reference significance for the diagnosis of (NB), small cell lung cancer and gastric cancer (signet ring cell carcinoma) of neuroblastoma. 4. Serum alkaline phosphatase (ALP),) lactate dehydrogenase (LDH),) carcinoembryonic antigen (CEA) was increased abnormally. It was suggested that bone marrow aspiration should be performed early to determine the presence of bone marrow infiltration in non-hematopoietic malignancies, and it was also a good index for screening, monitoring and predicting prognosis. 5. The pathological changes of bone marrow occurred during bone puncture, which indicated that bone marrow aspiration and biopsy could not only increase the positive rate of examination, but also identify the origin of primary tumor. 6. Early diagnosis of bone marrow metastases should focus on comprehensive analysis of cancer history, symptoms and signs, and laboratory examination.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R730.43

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