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目的:探讨骨髓转移瘤与浆细胞性骨髓瘤(PCM)的诊断与鉴别诊断要点。方法:对1例骨髓转移性低分化腺癌的骨髓涂片作Wright’s染色及PAS染色,骨髓活检(BMB)作塑料包埋H-Giemsa-E染色和嗜银染色。结果:患者,男,63岁,表现严重的腰腿痛,多发性骨质破坏,既往曾有结肠癌手术史。骨髓涂片可见98.5 %胞体较大,胞质丰富,核仁大的瘤细胞呈散在或小簇分布,红细胞呈缗钱状,血清IgA升高,初诊为PCM,但BMB示瘤细胞呈巢状排列,胞质丰富,有空泡。瘤细胞间无网状纤维,癌巢有网状纤维环绕。最后诊断为“骨髓转移性低分化腺癌”。对二者的发病年龄、症状与体征、骨髓细胞学、骨髓组织学以及影像学,血、尿免疫球蛋白定性与定量,瘤细胞免疫表型及IgH基因PCR检测的特点等作了鉴别。结论:BMB是诊断骨髓转移瘤和浆细胞性骨髓瘤的金标准。
Objective: To investigate the diagnosis and differential diagnosis of bone marrow metastases and plasma cell myeloma (PCM). Methods: One case of bone marrow metastatic poorly differentiated adenocarcinoma was treated with Wright’s staining and PAS staining. The bone marrow biopsy (BMB) was made of plastic-embedded H-Giemsa-E staining and silver staining. Results: The patient, male, 63 years old, had severe low back and leg pain, multiple bone destruction and previous colon cancer surgery. Bone marrow smear shows 98.5% of the large cell body, abundant cytoplasm, large nucleoli of tumor cells were scattered or small clusters of red blood cells showed Qian money-like, serum IgA increased, newly diagnosed as PCM, but BMB neoplasia neoplasms Arranged, rich in cytoplasm, empty bubble. Neoplastic cells without mesh fibers, cancer nest with reticular fibers around. Finally diagnosed as “bone marrow metastatic poorly differentiated adenocarcinoma.” The age of onset, symptoms and signs, bone marrow cytology, myelology and imaging, blood and urine immunoglobulin qualitative and quantitative, immunophenotype of tumor cells and IgH gene PCR detection characteristics were identified. Conclusion: BMB is the gold standard for the diagnosis of bone marrow metastases and plasma cell myeloma.