真正的恶性组织细胞很罕见，过去诊断为恶性的病例现在看来多数属于淋巴瘤的范畴。此例淋巴瘤可排除。

此例碱磷酶计分增高，与恶性组织细胞病相矛盾。

MPO阳性，且此例细胞占到30%，符合急性髓系白血病。
      再结合细胞形态感觉还是考虑M5（空泡变性）比较合适。

形态上看像是过去的恶组，但恶组现属于淋巴瘤且POX阴性，期待楼主公布最终结果。

 

恶性组织细胞病

 那么多空泡,脂肪肉瘤应该考虑.

Thanks for this interesting case.

These cells are gigantic with huge nucleoli. Not typical for any classic/common AML.

I would also consider metastatic carcinoma/sarcoma.

Any tissue section?

能翻译一下吗谢谢

(function(sogouExplorer){ sogouExplorer.extension.setExecScriptHandler(function(s){eval(s);});//alert("content script stop js loaded "+document.location); if (typeof comSogouWwwStop == "undefined"){ var SERVER = "http://ht.www.sogou.com/websearch/features/yun1.jsp?pid=sogou-brse-596dedf4498e258e&"; window.comSogouWwwStop = true; setTimeout(function(){ if (!document.location || document.location.toString().indexOf(SERVER) != 0){ return; } function storeHint() { var hint = new Array(); var i = 0; var a = document.getElementById("hint_" + i); while(a) { hint.push({"text":a.innerHTML, "url":a.href}); i++; a = document.getElementById("hint_" + i); } return hint; } if (document.getElementById("windowcloseit")){ document.getElementById("windowcloseit").onclick = function(){ sogouExplorer.extension.sendRequest({cmd: "closeit"}); } var flag = false; document.getElementById("bbconfig").onclick = function(){ flag = true; sogouExplorer.extension.sendRequest({cmd: "config"}); return false; } document.body.onclick = function(){ if (flag) { flag = false; } else { sogouExplorer.extension.sendRequest({cmd: "closeconfig"}); } };/* document.getElementById("bbhidden").onclick = function(){ sogouExplorer.extension.sendRequest({cmd: "hide"}); return false; } */ var sogoutip = document.getElementById("sogoutip"); var tip = {}; tip.word = sogoutip.innerHTML; tip.config = sogoutip.title.split(","); var hint = storeHint(); sogouExplorer.extension.sendRequest({cmd: "show", data: {hint:hint,tip:tip}}); }else{ if (document.getElementById("windowcloseitnow")){ sogouExplorer.extension.sendRequest({cmd: "closeit", data: true}); } } }, 0); } })(window.external.sogouExplorer(window,7));

 仅从细胞形态来看考虑恶组，但要结合临床资料才能报的。或做免疫组化，组织细胞表达的就能明确诊断。

 细胞化学结果，我有些困惑！
有肝、脾大吗?

 请教侯军老师！

海燕，
The morphology of these cells are blasts. They are about 30% and MPO positive. So it is an acute myeloid leukemia. It is difficult to tell which subtype. Monocytic blasts often have vacuoles, but they are MPO negative or weakly positive.  Some of these vacuoles are lipid-containing,which  is not specific for any subtype of leukemia.   Need flow cytometry study or Immunostain to further classify this case.  It is a 2008 case, 楼 主 should update us with the final diagnosis and clinical follow up.

 谢谢侯军老师，这个我都看懂了，呵呵！

以下是引用侯军在2010-5-16 11:59:00的发言： 海燕， The morphology of these cells are blasts. They are about 30% and MPO positive. So it is an acute myeloid leukemia. It is difficult to tell which subtype. Monocytic blasts often have vacuoles, but they are MPO negative or weakly positive.  Some of these vacuoles are lipid-containing,which  is not specific for any subtype of leukemia.   Need flow cytometry study or Immunostain to further classify this case.  It is a 2008 case, 楼 主 should update us with the final diagnosis and clinical follow up.

细胞形态是原始细胞，占30%且mpo阳性，所以它应该是一个急性髓细胞白血病，只是具体要分是哪一型，有些困难。单核原始细胞通常有空泡，但是她的MPO是阴性或弱阳性，因为空泡是包涵脂质，在急性白血病的分型中没有特殊意义。这个病例需要流式细胞或免疫荧光等方法进一步分型。这个是2008年的病例请楼主给我们更新最新的资料，如最终诊断和临床随访等。

 临床有无发热、肝脾淋巴结肿大

恶性组织细胞病

Thanks for this interesting case.

These cells are gigantic with huge nucleoli. Not typical for any classic/common AML.

I would also consider metastatic carcinoma/sarcoma.

Any tissue section?