- 期刊
Bone Marrow Necrosis and Malignancy: A Single Institution Experience
骨髓壞死與惡性腫瘤－高雄榮民總醫院的經驗
摘要
回顧高雄榮總自民國89年至91年的12年間，所有2947個骨髓切片中，我們發現有11例骨髓壞死。所有的病例均為惡性腫瘤，包括7例固態腫瘤，2例淋巴瘤及2例急性淋巴性白血病。常見的症狀有骨痛、發燒。實驗室檢驗常發現有貧血、血小板降低及母白血球過多症(leucoerythroblastosis)以及異常LDH的上升。其中4例有不等程度的瀰漫性血管內凝結(disseminated intravascular coagulation)。在10個骨髓抽取的抹片中，只有2例有骨髓壞死，有6例是抽取失敗，另外2例只發現癌細胞。相對於骨髓切片時所做的印跡(touch imprint)抹片，10例中有8例呈現不等程度的壞死。我們建議，假設臨床上懷疑有骨髓壞死的個案，必須做多次和多部位的骨髓抽取及骨髓切片，以利診斷。骨髓切片的印跡也可幫助診斷。尋找潛在的惡性腫瘤疾病是必要的。
關鍵字
無資料並列摘要
In this retrospective analysis, 11 cases of bone marrow necrosis (BMN) were diagnosed among 2947 consecutive bone marrow (BM) biopsies between 1990 and 2002. The prevalence was found to be 0.4%. All cases had underlying malignancies, 7 solid tumors, 2 non-Hodgkin's lymphoma and 2 Acute Lymphoblastic Leukemia. The most common laboratory findings were anemia (11/11), leucoerythroblastosis (9/11) and thrombocytopenia (7/11). High serum level of LDH, alkaline phosphatase and aspartate aminotransferase were detected in all available cases. Four cases underwent coagulation study and all of them showed different degrees of disseminated intravascular coagulation (DIC) reactions. BMN was graded according to extent of necrosis in the BM biopsies, and almost was severe necrosis type except one moderate type. BMN was positive in only 2 of 10 BM aspiration smears. Among the eight negative aspirations, six failed due to dry tap and 2 of tumor infiltrations without BMN. In contrast, 8 of 10 touch imprints showed BMN of different degree. In conclusion, when BMN was suspected clinically, multiple aspiration and BM biopsy are necessary to made diagnosis. Touch imprint is also useful. It requires search for underlying malignant disease.