12例急性双系列白血病细胞形态学与免疫表型分析

doi:10.3969/j.issn.1673-8640.2015.05.009

检验医学 ›› 2015, Vol. 30 ›› Issue (5): 446-449.DOI: 10.3969/j.issn.1673-8640.2015.05.009

12例急性双系列白血病细胞形态学与免疫表型分析

范立权¹, 陈伟琴², 王剑飚³, 盛燕¹, 吴婧¹

1. 上海交通大学医学院附属瑞金医院血液研究所,上海 200025
2. 上海中医药大学附属龙华医院检验科,上海 200232
3. 上海交通大学医学院附属瑞金医院检验科,上海 200025

收稿日期:2014-07-08 出版日期:2015-05-30 发布日期:2015-06-17
作者简介:null
作者简介:范立权,男,1973年生,主管技师,主要从事骨髓细胞形态学研究。

通讯作者:王剑飚,联系电话:021-64370045-600612。

Cell morphology and immunophenotype in 12 patients of acute bilineage leukemia

FAN Liquan¹, CHEN Weiqin², WANG Jianbiao³, SHENG Yan¹, WU Jing¹

1. Institute of Blood Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
2. Department of Clinical Laboratory, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200232, China
3. Department of Clinical Laboratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

Received:2014-07-08 Online:2015-05-30 Published:2015-06-17

摘要/Abstract

摘要： 目的探讨急性双系列白血病(aBLL)细胞形态学与免疫表型的关系。方法回顾分析12例aBLL 患者的骨髓细胞形态、组织化学染色,同时进行免疫表型(HLA-DR、CD34、MPO、CD13、CD33、CD11b、CD117、CD14、CD64、CD3、CD4、CD7、CD10、CD19、CD20、CD22、CD79a)检测。结果 12例aBLL患者FAB分型与免疫表型分型既有一定的差异性,同时也有较好的互补性。12例aBLL患者中,细胞形态学诊断为急性髓细胞白血病(AML)6例,其中4例为M2、2例为M1;2例诊断为急性混合细胞白血病(AMLL);4例诊断为急性淋巴细胞白血病(ALL-L2)。免疫表型诊断为aBLL的12例中髓-B淋巴细胞混合(My-B)10例、髓-T淋巴细胞混合(My-T)2例。结论 aBLL是一种少见类型的白血病,免疫表型与细胞形态学有一定的互补性,能有效降低aBLL的误诊率和漏诊率。

关键词: 免疫表型, 急性双系列白血病, 细胞形态学

Abstract: Objective To investigate the relationship between cell morphology and immunophenotype of acute bilineage leukemia(aBLL). Methods A total of 12 aBLL patients were enrolled, and the marrow cell morphology and histochemistry staining were performed. The immunophenotype was detected, including HLA-DR, CD34, MPO, CD13, CD33, CD11b, CD117, CD14, CD64, CD3, CD4, CD7, CD10, CD19, CD20, CD22 and CD79a. Results There were not only some differences but also complementaries between FAB and immunophenotype classification of aBLL. Of the 12 aBLL patients, 6 cases were diagnosed by cell morphology as acute myeloid leukemia (AML) [M2(4 cases) and M1(2 cases)], 2 cases as acute mixed lineage leukemia (AMLL) and 4 cases as ALL-L2, respectively. The 12 cases were diagnosed by immunophenotype classification as aBLL, while 10 cases were myeloid-B lymphocyte mix (My-B), and 2 cases were myeloid-T lymphocyte mix(My-T). Conclusions aBLL is a rare type of leukemia. The complementarity between immunophenotype and cell morphology can effectively reduce the misdiagnosis and missed diagnosis of aBLL.

Key words: Immunophenotype, Acute bilineage leukemia, Cell morphology

中图分类号:

R446.11

范立权, 陈伟琴, 王剑飚, 盛燕, 吴婧. 12例急性双系列白血病细胞形态学与免疫表型分析[J]. 检验医学, 2015, 30(5): 446-449.

FAN Liquan, CHEN Weiqin, WANG Jianbiao, SHENG Yan, WU Jing. Cell morphology and immunophenotype in 12 patients of acute bilineage leukemia[J]. Laboratory Medicine, 2015, 30(5): 446-449.

图/表 5

参考文献 9

[1]	张之南. 血液病诊断及疗效标准[M].3版.北京:科学出版社,2007:112-115.
[2]	BENE MC,CASTOLDI G,KNAPP W,et al.Proposals for the immunological classification of acute leukemias. European Group for the Immunological Characterization of Leukemias(EGIL)[J]. Leukemia,1995,9(10):1783-1786.
[3]	张纯,李睿,赵菲,等.急性白血病形态学与免疫学分型的关系[J].中国癌症杂志,2007,17(8):615-618.
[4]	林果为,欧阳仁荣,陈珊珊,等,现代临床血液病[M].上海:复旦大学出版社,2013:126-127.
[5]	FRATER JL,YASEEN NR,PETERSON LC,et al.Biphenotypic acute leukemia with coexpression of CD79a and markers of myeloid lineage[J].Arch Pathol Lab Med,2003,127(3):356-359.
[6]	叶蕾,林冬,秘营昌,等.混合表型急性白血病EGIL1998诊断积分系统和WHO2008诊断分型标准比较[J].中华血液学杂志,2012,33(4):286-290.
[7]	LEGRAND O,PERROT JY,SIMONIN G,et al.Adult biphenotypic acute leukemia:an entity with poor prognosis which is related to unfavourable cytogenetics and P-glycoprotein over-expression[J].Br J Haematol,1998,100(1):147-155.
[8]	要跟东,霍红旗,李鹏,等.双表型急性白血病流式细胞术免疫分型检测结果[J].白血病·淋巴瘤,2011,20(2):103-104.
[9]	TESTA U,TORELLI GF,RICCIONI R, et al.Human acute stem cell leukemia with multilineage differentiation potential via cascade activation of growth factor receptors[J].Blood,2002,99(12):4634-4637.

积分	髓系	B-淋巴细胞系	T-淋巴细胞系
2	MPO	CD79a、cIgM、cCD22	CD3(m/cyt)、TCR
1	CD117、CD13、CD33、CD65	CD19、CD10、CD20	CD2、CD5、CD8、CD10
0.5	CD14、CD15、CD64	TdT、CD24	TdT、CD7、CD1a

积分	髓系	B-淋巴细胞系	T-淋巴细胞系
2	MPO	CD79a、cIgM、cCD22	CD3(m/cyt)、TCR
1	CD117、CD13、CD33、CD65	CD19、CD10、CD20	CD2、CD5、CD8、CD10
0.5	CD14、CD15、CD64	TdT、CD24	TdT、CD7、CD1a

病例	FAB分型	系列积分			骨髓幼稚细胞	POX
病例	FAB分型	髓系			B系	T系
1	AML-M2	4	5	0	0.820	(+)19%
2	AML-M2	4.5	5	0	0.790	(+)21%
3	AML-M2	4.5	5	0	0.850	(+)30%
4	AML-M2	4	5	0	0.865	(+)29%
5	AML-M1	5	0	2.5	0.910	(+)17%
6	AML-M1	4	0	2.5	0.950	(+)15%
7	AMLL	4	6	0	0.770	(+)11%
8	AMLL	4	6	0	0.830	(+)10%
9	ALL-L2	4	6	0	0.775	(-)100%
10	ALL-L2	4	4	0	0.880	(-)100%
11	ALL-L2	4	6	0	0.895	(-)100%
12	ALL-L2	4	6	0	0.840	(-)100%

病例	FAB分型	系列积分			骨髓幼稚细胞	POX
病例	FAB分型	髓系			B系	T系
1	AML-M2	4	5	0	0.820	(+)19%
2	AML-M2	4.5	5	0	0.790	(+)21%
3	AML-M2	4.5	5	0	0.850	(+)30%
4	AML-M2	4	5	0	0.865	(+)29%
5	AML-M1	5	0	2.5	0.910	(+)17%
6	AML-M1	4	0	2.5	0.950	(+)15%
7	AMLL	4	6	0	0.770	(+)11%
8	AMLL	4	6	0	0.830	(+)10%
9	ALL-L2	4	6	0	0.775	(-)100%
10	ALL-L2	4	4	0	0.880	(-)100%
11	ALL-L2	4	6	0	0.895	(-)100%
12	ALL-L2	4	6	0	0.840	(-)100%

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[5]	余金丽, 刘建, 魏俊岩, 杨丽, 卞淑慧. 慢性粒单核细胞白血病伴环形铁粒幼细胞增多1例报道[J]. 检验医学, 2020, 35(5): 506-507.
[6]	潘雪, 陶慧娟, 周道银, 徐健, 陈燕. 尿液细胞形态学检查在膀胱癌诊断中的应用[J]. 检验医学, 2020, 35(1): 84-86.
[7]	杨翌翔, 韦薇, 彭亮, 侯彦强. 区域化医疗网络内检验人员血细胞形态识别能力调查[J]. 检验医学, 2019, 34(5): 463-465.
[8]	王霞, 张斌. 混合表型急性白血病患者骨髓细胞形态学与流式免疫表型特点[J]. 检验医学, 2019, 34(3): 235-239.
[9]	孙烨, 郭平, 熊树民, 吴蓉, 康向东. 肥大细胞白血病临床和实验室检查回顾分析[J]. 检验医学, 2019, 34(2): 180-184.
[10]	冯一, 傅佳萍. T幼淋巴细胞白血病1例报道[J]. 检验医学, 2018, 33(5): 466-468.
[11]	白萍, 许雯, 秦尤文, 李莉. 骨髓中原始细胞比例为10%的急性髓系白血病1例报道[J]. 检验医学, 2018, 33(4): 374-375.
[12]	李佳, 高晓娟, 王亚奇, 王宁宁, 岳保红. 1例少见浆母细胞骨髓瘤的实验室诊断及文献复习[J]. 检验医学, 2018, 33(10): 958-961.
[13]	郭平, 陈骊婷, 宋卫星, 石厚荣, 王剑飚. 快速流式细胞术用于外周血原始细胞检测性能临床评价[J]. 检验医学, 2017, 32(5): 421-426.
[14]	刘帅, 李曌博, 张帆, 王宁宁, 岳保红. 37例CD45阳性的多发性骨髓瘤浆细胞免疫学表型特征[J]. 检验医学, 2017, 32(2): 76-80.
[15]	刘帅, 魏园玉, 李曌博, 张帆, 王宁宁, 李佳, 岳保红. 利妥昔单抗靶向治疗B细胞性非霍奇金淋巴瘤后骨髓中淋巴细胞的免疫表型特点[J]. 检验医学, 2017, 32(10): 945-946.

12例急性双系列白血病细胞形态学与免疫表型分析

Cell morphology and immunophenotype in 12 patients of acute bilineage leukemia

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参考文献 9

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Metrics

病例	CD3	CD4	CD5	CD7	CD10	CD19	CD20	CD22	CD79a
1	0	11	0	1	0	89	3	75	90
2	1	0	0	0	1	77	2	73	54
3	0	0	0	0	5	78	4	68	65
4	0	12	2	0	9	98	7	92	88
5	29	3	0	91	0	0	0	0	0
6	25	4	0	90	0	0	0	0	0
7	1	0	0	14	72	75	2	48	51
8	0	2	0	0	25	79	4	47	80
9	0	12	2	0	99	98	7	92	88
10	0	5	1	0	74	93	0	6	93
11	0	11	9	16	59	72	2	30	61
12	1	3	0	14	75	65	2	28	60

病例	CD3	CD4	CD5	CD7	CD10	CD19	CD20	CD22	CD79a
1	0	11	0	1	0	89	3	75	90
2	1	0	0	0	1	77	2	73	54
3	0	0	0	0	5	78	4	68	65
4	0	12	2	0	9	98	7	92	88
5	29	3	0	91	0	0	0	0	0
6	25	4	0	90	0	0	0	0	0
7	1	0	0	14	72	75	2	48	51
8	0	2	0	0	25	79	4	47	80
9	0	12	2	0	99	98	7	92	88
10	0	5	1	0	74	93	0	6	93
11	0	11	9	16	59	72	2	30	61
12	1	3	0	14	75	65	2	28	60

病例	MPO	CD13	CD33	CD11b	CD14	CD64	CD117	CD34	HLA-DR
1	16	70	97	13	8	9	3	91	90
2	23	35	95	7	9	36	2	64	79
3	14	29	99	12	6	24	1	81	84
4	11	33	85	6	9	5	3	98	99
5	20	49	55	3	0	0	12	39	0
6	13	76	15	2	0	0	20	60	0
7	34	61	65	24	3	9	2	63	81
8	15	83	71	19	0	3	3	91	95
9	11	33	85	76	9	5	3	98	99
10	17	33	77	6	0	0	5	95	100
11	15	59	67	7	0	0	0	82	65
12	13	61	65	24	3	7	2	67	82

病例	MPO	CD13	CD33	CD11b	CD14	CD64	CD117	CD34	HLA-DR
1	16	70	97	13	8	9	3	91	90
2	23	35	95	7	9	36	2	64	79
3	14	29	99	12	6	24	1	81	84
4	11	33	85	6	9	5	3	98	99
5	20	49	55	3	0	0	12	39	0
6	13	76	15	2	0	0	20	60	0
7	34	61	65	24	3	9	2	63	81
8	15	83	71	19	0	3	3	91	95
9	11	33	85	76	9	5	3	98	99
10	17	33	77	6	0	0	5	95	100
11	15	59	67	7	0	0	0	82	65
12	13	61	65	24	3	7	2	67	82

病例	CD3	CD4	CD5	CD7	CD10	CD19	CD20	CD22	CD79a
1	0	11	0	1	0	89	3	75	90
2	1	0	0	0	1	77	2	73	54
3	0	0	0	0	5	78	4	68	65
4	0	12	2	0	9	98	7	92	88
5	29	3	0	91	0	0	0	0	0
6	25	4	0	90	0	0	0	0	0
7	1	0	0	14	72	75	2	48	51
8	0	2	0	0	25	79	4	47	80
9	0	12	2	0	99	98	7	92	88
10	0	5	1	0	74	93	0	6	93
11	0	11	9	16	59	72	2	30	61
12	1	3	0	14	75	65	2	28	60

病例	CD3	CD4	CD5	CD7	CD10	CD19	CD20	CD22	CD79a
1	0	11	0	1	0	89	3	75	90
2	1	0	0	0	1	77	2	73	54
3	0	0	0	0	5	78	4	68	65
4	0	12	2	0	9	98	7	92	88
5	29	3	0	91	0	0	0	0	0
6	25	4	0	90	0	0	0	0	0
7	1	0	0	14	72	75	2	48	51
8	0	2	0	0	25	79	4	47	80
9	0	12	2	0	99	98	7	92	88
10	0	5	1	0	74	93	0	6	93
11	0	11	9	16	59	72	2	30	61
12	1	3	0	14	75	65	2	28	60

病例	MPO	CD13	CD33	CD11b	CD14	CD64	CD117	CD34	HLA-DR
1	16	70	97	13	8	9	3	91	90
2	23	35	95	7	9	36	2	64	79
3	14	29	99	12	6	24	1	81	84
4	11	33	85	6	9	5	3	98	99
5	20	49	55	3	0	0	12	39	0
6	13	76	15	2	0	0	20	60	0
7	34	61	65	24	3	9	2	63	81
8	15	83	71	19	0	3	3	91	95
9	11	33	85	76	9	5	3	98	99
10	17	33	77	6	0	0	5	95	100
11	15	59	67	7	0	0	0	82	65
12	13	61	65	24	3	7	2	67	82

病例	MPO	CD13	CD33	CD11b	CD14	CD64	CD117	CD34	HLA-DR
1	16	70	97	13	8	9	3	91	90
2	23	35	95	7	9	36	2	64	79
3	14	29	99	12	6	24	1	81	84
4	11	33	85	6	9	5	3	98	99
5	20	49	55	3	0	0	12	39	0
6	13	76	15	2	0	0	20	60	0
7	34	61	65	24	3	9	2	63	81
8	15	83	71	19	0	3	3	91	95
9	11	33	85	76	9	5	3	98	99
10	17	33	77	6	0	0	5	95	100
11	15	59	67	7	0	0	0	82	65
12	13	61	65	24	3	7	2	67	82

病例	CD3	CD4	CD5	CD7	CD10	CD19	CD20	CD22	CD79a
1	0	11	0	1	0	89	3	75	90
2	1	0	0	0	1	77	2	73	54
3	0	0	0	0	5	78	4	68	65
4	0	12	2	0	9	98	7	92	88
5	29	3	0	91	0	0	0	0	0
6	25	4	0	90	0	0	0	0	0
7	1	0	0	14	72	75	2	48	51
8	0	2	0	0	25	79	4	47	80
9	0	12	2	0	99	98	7	92	88
10	0	5	1	0	74	93	0	6	93
11	0	11	9	16	59	72	2	30	61
12	1	3	0	14	75	65	2	28	60

病例	CD3	CD4	CD5	CD7	CD10	CD19	CD20	CD22	CD79a
1	0	11	0	1	0	89	3	75	90
2	1	0	0	0	1	77	2	73	54
3	0	0	0	0	5	78	4	68	65
4	0	12	2	0	9	98	7	92	88
5	29	3	0	91	0	0	0	0	0
6	25	4	0	90	0	0	0	0	0
7	1	0	0	14	72	75	2	48	51
8	0	2	0	0	25	79	4	47	80
9	0	12	2	0	99	98	7	92	88
10	0	5	1	0	74	93	0	6	93
11	0	11	9	16	59	72	2	30	61
12	1	3	0	14	75	65	2	28	60

病例	MPO	CD13	CD33	CD11b	CD14	CD64	CD117	CD34	HLA-DR
1	16	70	97	13	8	9	3	91	90
2	23	35	95	7	9	36	2	64	79
3	14	29	99	12	6	24	1	81	84
4	11	33	85	6	9	5	3	98	99
5	20	49	55	3	0	0	12	39	0
6	13	76	15	2	0	0	20	60	0
7	34	61	65	24	3	9	2	63	81
8	15	83	71	19	0	3	3	91	95
9	11	33	85	76	9	5	3	98	99
10	17	33	77	6	0	0	5	95	100
11	15	59	67	7	0	0	0	82	65
12	13	61	65	24	3	7	2	67	82

病例	MPO	CD13	CD33	CD11b	CD14	CD64	CD117	CD34	HLA-DR
1	16	70	97	13	8	9	3	91	90
2	23	35	95	7	9	36	2	64	79
3	14	29	99	12	6	24	1	81	84
4	11	33	85	6	9	5	3	98	99
5	20	49	55	3	0	0	12	39	0
6	13	76	15	2	0	0	20	60	0
7	34	61	65	24	3	9	2	63	81
8	15	83	71	19	0	3	3	91	95
9	11	33	85	76	9	5	3	98	99
10	17	33	77	6	0	0	5	95	100
11	15	59	67	7	0	0	0	82	65
12	13	61	65	24	3	7	2	67	82