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骨髓坏死(BMN)的诊断在生前常被忽视。本文首次报导2例未经治疗的恶性淋巴瘤患者发生BMN,2例均在生前作出BMN的诊断。例1,76岁,男,1977年7月因“癫痫”的发作而就诊。一个月后左腿发生血栓性静脉炎。各种实验室检查包括骨髓检查基本正常。经抗凝治疗症状消退出院。78年1月再入院,情况差。呈木僵、脱水状态。腹部膨胀伴多数痛性癌性肿块,出现贫血及血小板减少。血液学分类星红白母细胞血象,毒性颗粒,Doh-le小体,多染性细胞增多,红细胞碎片及泪滴状红细胞。有尿毒症及肝功不佳,LDH显著升高。胸骨穿刺得黄棕色抽出物,MGG染色涂片示坏死物质伴一些单核细胞,诊断为BMN一天后死亡。尸检发现腹腔内有大块肿瘤,为起源于小肠的高度恶性淋母细胞瘤伴广泛转移,证实淋巴瘤侵入骨髓并有多灶性坏死。
The diagnosis of bone marrow necrosis (BMN) is often overlooked in life. This article first reported 2 cases of untreated malignant lymphoma in patients with BMN, 2 patients were diagnosed before birth to make BMN. Example 1,76 years old, male, July 1977 Visited for Epilepsy. Thrombophlebitis occurred on the left leg a month later. A variety of laboratory tests including bone marrow examination was normal. After anticoagulant treatment of symptoms subsided. In January 1978 re-admission, the situation is poor. Was stupid, dehydrated state. Abdominal swelling with the majority of painful cancerous mass, anemia and thrombocytopenia. Hematological classification Astragalus cell blood, toxic particles, Doh-le bodies, polycythemia, erythrocyte debris and teardrop-shaped erythrocytes. With uremia and poor liver function, LDH was significantly higher. The sternum punctured yellow-brown extract, MGG staining showed necrotic material with some mononuclear cells, one day after the diagnosis of BMN death. An autopsy revealed a large intraperitoneal tumor that was extensively metastasised to highly malignant lymphoblastoma originating in the small intestine, confirming the invasion of lymphoma into the bone marrow and multifocal necrosis.