后纵隔细针穿刺细胞病理诊断髓外造血并文献复习

摘要

To study the feasibility of in a A patient with extramedullary hematopoiesis presenting as a posterior mediastinal tumor underwent fine-needle aspiration for cell pathology diagnosis.The primary locus of a posterior mediastinal extramedullary hematopoiesis was examined with Papanicolaou staining and HE staining,and the expressions of cytokeratin,epithelial membrane antigen (EMA),terminal deoxynucleotidyl transferase,CD3,CD20,anaplastic lymphoma kinase,CD34,CD235a,myeloperoxidase,CD61,P53,CD30,S-100,CD1a,and Ki-67 with immunohistochemistry.The results were analyzed of bone marrow biopsy and cell smears,examination of chromosome structure and number,and detection of BCR/ABL fusion gene using fluorescence in situ hybridization.Examination of cell pathology of fine-needle aspiration in the posterior mediastinal focus revealed scatter cells of heterogeneous sizes consisting mainly of erythroid cells,and granulocytes and erythroid cells at different stages and lobulated large mature megakaryocytes were found.The eythroid cells in the core biopsy tissue were distributed in multiple cell islands.Immunohistochemistry showed positive results for erythroid cell CD235a,granulocyte MPO,megakaryocyte CD61,and Ki-67 (about 90％).Examination of the bone barrow biopsy tissue and cell smear also showed the changes of hyperplastic anemia without clone structure or abnormal number of the chromosomes,and no BCR/ABL fusion gene was detected by fluorescence in situ hybridization.Fine-needle aspiration cell pathology combined with the patient's clinical data allows the diagnosis of extramedullary hematopoiesis in the rare site of the posterior mediastinum.%目的 探究细针穿刺细胞学诊断髓外造血细胞可行性.方法 对1例后纵隔髓外造血灶穿刺细胞涂片行Papanicolaou染色、粗针穿刺活检组织常规制片行HE染色,光镜观察;免疫组化检测细胞角蛋白、上皮膜抗原、末端脱氧核苷酰酶酸转移酶、CD3、CD20、间变性淋巴瘤激酶、CD34、CD235a、髓过氧化物酶、CD61、P53、CD30、S-100、CD1a、Ki-67表达;分析临床骨髓活检和细胞涂片、染色体结构和数目、BCR/ABL融合基因FISH检测.结果 后纵隔病灶穿刺细胞大小不一,散在分布,以红系细胞为主,可见不同阶段粒系细胞、红系细胞和分叶状体积大的成熟巨核细胞;穿刺活检组织内红细胞多呈岛状分布;免疫组化红系细胞CD235a(+)、髓系细胞髓过氧化物酶(+)、巨核细胞CD61(+),Ki67(+,约90％);骨髓活检和细胞涂片为增生性贫血改变,染色体未见克隆性结构和数目异常,未见BCR/ABL融合基因信号.结论 细针穿刺细胞学结合临床资料可以做出后纵隔这种少见部位髓外造血的病理诊断.