ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The bone marrow is a complex organ, with dynamic hematopoietic and immunologic functions. Disseminated within the intertrabecular and medullary spaces of the bones, it is estimated to be the same size as the liver. Because diagnostic samples are small representations of the total marrow, it is important that material be adequate, representative, and of high technical quality. A preview of the clinical profile, the complete blood count, and the peripheral blood smear will ensure that a minimum of additional ancillary testing is necessary to establish a diagnosis in these times of cost containment. Whereas newer technologies have enriched our understanding of pathogenesis and simplified cellular identification, it is important not to abandon the central role of light microscopy. Presented herein is a general review of bone marrow examination; indications for the same; logistics of procurement; a breakdown of procedures ideally suited for specimen components; and guidelines for interpretation and data integration according to cell line, tissue compartment, and pathogenic process.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;The 5q‐ syndrome is a clinicopathologic entity that occurs predominantly in elderly women and is characterized by macrocytic anemia, a normal or elevated platelet count, a normal leukocyte count or insignificant leukopenia, distinctive micromegakaryocytes with hypolobulated nuclei, and del(5q) as the sole cytogenetic abnormality detected in the bone marrow. Patients with 5q‐ have a favorable prognosis because they have relatively fewer infections and bleeding problems and a lower risk of progression to acute myeloid leukemia (AML) than do patients with other myelodysplastic syndromes (MDS). However, del(5q) also can occur inde novoand therapy‐related AML and MDS; patients with these disorders have a poorer prognosis. A case of refractory anemia with excess blasts associated with del(5q) is reported that the authors believe is not example of the 5q‐ syndrome. Laboratory and morphologic features useful in distinguishing the 5q‐ syndrome from other forms of MDS with del(5q) are discussed. The French‐American‐British (FAB) and newly proposed World Health Organization (WHO) classification systems for MDS are also reviewed.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Acute myeloid leukemia (AML) with abnormal bone marrow eosinophils and inv(16)(p13;q22) or t(16;16)(p13; q22) is a distinct type of AML designated as M4Eo by the French‐American‐British (FAB) group. AML‐M4Eo is characterized by myelomonocytic differentiation accompanied by pathologic eosinophils containing abnormally large basophilic granules that are positive for myeloperoxidase, chloroacetate esterase, and periodic acid‐Schiff (PAS). Immunophenotypic studies have shown that AML‐M4Eo expresses myeloid markers and that some cases coexpress the T‐cell‐associated antigen CD2. Cytogenetic analysis of AML‐M4Eo reveals a pericentric inversion, inv(16)(p13;q22); or less commonly, the translocation t(16;16)(p13;q22). These molecular abnormalities result in the juxtaposition of theCBF&bgr; gene at 16q22 with theMYH11 gene at 16p13, creating a novelCBF&bgr;/MYH11 fusion gene that causes leukemogenesis and a loss of function of the core binding factor protein complex. The overall prognosis for patients with AML‐M4Eo is favorable. The recently proposed World Health Organization (WHO) classification of myeloid neoplasms recognizes AMLs with recurrent cytogenetic translocations as distinct clinicopathologic entities, one of which is AML‐M4Eo. The differential diagnosis of AML‐M4Eo is discussed.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Burkitt lymphoma is a distinctive type of non‐Hodgkin lymphoma that has characteristic morphologic, immunophenotypic, and molecular genetic features. Patients can have predominantly peripheral blood and bone marrow involvement. The World Health Organization has recommended that these cases should be diagnosed as the leukemic phase of Burkitt lymphoma. The authors present a case of Burkitt lymphoma in leukemic phase and discuss the differential diagnosis. The neoplastic cells of Burkitt lymphoma in Wright‐stained bone marrow aspirate smears are blasts with round nuclei, one to several small distinct nucleoli, and abundant deeply basophilic, vacuolated cytoplasm. Immunophenotypic analysis demonstrates that Burkitt lymphoma is a mature B‐cell neoplasm that expresses B‐cell antigens, CD10, and monotypic surface immunoglobulin. Cytogenetic and molecular studies demonstrate one of three characteristic chromosomal translocations: t(8;14)(q24;q32), t(8;22)(q24;q11), or t(2;8)(p11;q24). These translocations join the c‐mycgene at 8q24 with one of the immunoglobulin gene loci, either the heavy chain gene at 14q32, the &kgr; light chain gene at 22q11, or the &lgr; light chain gene at 2p11. Translocation results in overexpression of the c‐myc protein, which regulates transcription and cell proliferation.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;B‐cell prolymphocytic leukemia (B‐PLL) is a rare lymphoproliferative disorder with clinical, morphologic, and immunophenotypic features that overlap with other mature B‐cell leukemias and lymphomas. Patients with B‐PLL typically have marked splenomegaly and leukocytosis, have no significant lymphadenopathy, and have a clinically aggressive course and poor prognosis. In peripheral blood (PB) and bone marrow (BM) aspirate smears, numerous large prolymphocytes with a round to oval nucleus and a single large nucleolus are observed. The French‐American‐British group recommends requiring that >55% prolymphocytes be present in the PB (or BM) to establish the diagnosis of B‐PLL. In BM biopsy sections, B‐PLL extensively replaces the medullary space in a pattern that is diffuse, interstitial, or both. Immunophenotypic studies have shown that B‐PLL patients express monotypic immunoglobulin light chain (of bright intensity) and pan‐B‐cell antigens, and variably express the CD5 antigen. Cytogenetic studies have reported several chromosomal abnormalities, which are usually complex. The differential diagnosis of B‐PLL is reviewed.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Bone marrow involvement by large B‐cell lymphoma usually occurs in patients with widely disseminated disease. Rare cases may appear initially in the bone marrow, usually with evidence of concurrent hepatic and/or splenic involvement. The author presents a case of “marrow‐only” large B‐cell lymphoma and reviews the previous literature, contrasting it with the more common bone and bone marrow manifestations of large cell lymphoma. The author also considers the primary differential diagnoses including small noncleaved cell lymphoma/L3 acute lymphoid leukemia, anaplastic myeloma, and acute myelogenous leukemia. Correlation with the clinical features, peripheral blood findings, and morphologic features of the biopsy and aspirate allows distinction between these entities. Immunostaining and/or flow cytometric immunophenotypic analysis can provide confirmation of the diagnosis.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

&NA;Hodgkin disease (HD) can involve the bone marrow (BM) with a reported incidence at time of initial staging that ranges from <5% to 20%. The presence of BM involvement by HD correlates with many factors including advanced nodal disease, systemic symptoms, age, peripheral blood cytopenias, tumor bulk, and histologic type of HD. The authors describe the case of a 43‐year‐old woman with a history of stage IB mixed cellularity HD who relapsed with HD in BM 9 months later. Bone marrow aspirate smears were negative for HD, but the biopsy specimen was extensively involved by HD, which was characterized by numerous mononuclear neoplastic cells and occasional Reed‐Sternberg cells in a mixed cellular background of eosinophils, plasma cells, and histiocytes with extensive fibrosis. Immunohistochemical studies of the neoplastic cells were positive for CD15, CD30, and Epstein‐Barr virus latent membrane protein type 1, supporting the diagnosis of HD. The role of BM biopsy in staging, the criteria for the diagnosis of HD in BM, and the role of immunohistochemical studies are reviewed. The differential diagnosis of HD involving the BM is also discussed.

ISSN:1082-9784    

出版商:OVID    

年代:2000

数据来源: OVID