| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 骨髓活检-儿童
| 姓 名： | ××× | 性别： | 女 | 年龄： | 4+岁 |
| 标本名称： | 骨髓穿刺活检 | ||||
| 简要病史： | 患儿女，4+岁，以“发热7天，查血三系下降2天”入院。查体：T38.5，肝肋下3cm，脾肋下1cm。颈部及腹股沟可扪及2-3个黄豆大淋巴结，质中，可活动，无压痛。血常规：红细胞3.21*1012/L，血红蛋白87g，血小板50*109/L，白细胞1.1*109/L，N 0.35，L 0.61。腹部CT：肝脏可见轻度胆汁淤积，肝脏、脾脏不大，未见结节。骨髓涂片三次，均为成熟红细胞，未见髓系成分。临床诊断：ALL？MDS？ | ||||
| 肉眼检查： | 骨髓组织一段，长0.8cm，直径0.3cm | ||||
1.HE-40-1
2.HE-40-2
3.HE-200-1
4.HE-200-2
5.HE-400-1
6.HE-400-2
7.HE-400-3
8.HE-400-4
9.HE-400-5
10.银染-200-1
11.CD61-200-1
12.MPO-200-1
13.CD235a-200-1
目前考虑诊断：1.再生障碍性贫血？2.MDS？
图3、5、7中的体积较大、核不规则的细胞，CD61（+），CD3、CD20、ALK、CD30（-）
标签：
×参考诊断
-
The marrow is slightly hypocellular for this age. All three lineages are present although the numbers are decreased. I did not see any abnormal clusters of immature cells. The pictures do not support the diagnosis of acute leukemia or aplastic anemia. In the photos provided, I did not see any giant erythroblasts with viral inclusions. However, additional serologic study should be performed to rule out the parvovirus-related erythroblastopenia. Is there any medication given during this time? Any infection was discovered?
Overall, I do not think there is a specific diagnosis from this bone marrow. I agree with 海燕 that the findings maybe due to an infectious etiology or medication given. Good marrow aspirate smear and flow cytometry study are always helpful.
| 以下是引用侯军在2010-5-26 3:44:00的发言： The marrow is slightly hypocellular for this age. All three lineages are present although the numbers are decreased. I did not see any abnormal clusters of immature cells. The pictures do not support the diagnosis of acute leukemia or aplastic anemia. In the photos provided, I did not see any giant erythroblasts with viral inclusions. However, additional serologic study should be performed to rule out the parvovirus-related erythroblastopenia. Is there any medication given during this time? Any infection was discovered? Overall, I do not think there is a specific diagnosis from this bone marrow. I agree with 海燕 that the findings maybe due to an infectious etiology or medication given. Good marrow aspirate smear and flow cytometry study are always helpful.
|
对于该年龄的患者而言，骨髓里细胞数减少。但是尽管数量减少，所有三系都存在。我没有看到任何异常分化的不成熟的细胞。这些图片不支持急性白血病或者再生障碍性贫血的诊断。在提供的照片中，我没有看到任何伴有病毒包涵体的巨幼红细胞。然而，需要进行额外的的血清学检查来排除细小病毒相关的幼红细胞减少症。在这个期间是否给过任何药物？发现任何感染？
整体上，我不认为从骨髓上能得出任何特异性的诊断。我同意海燕的意见，这些现象可能是由于感染的原因或者所给的药物引起。好的骨髓涂片和流式细胞仪总是有帮助的。
