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本文报道13例恶性肿瘤以骨髓转移为首发表现而致误诊的经验.男11例,女2例,年龄21～67岁.出现骨髓转移癌(McBM)症状至确诊时间:<半月1例,1～2月7例,3～6月5例.12例是在骨髓涂片中发现转移癌细胞后确诊,1例尸检证实.9例找到原发肿瘤,其中胃癌5例,结肠癌、乳腺癌、肺癌和前列腺癌各1例,原发灶不明者4例.临床表现:13例 McBM 均有贫血(27～98g/L).骨关节痛8例,但仅1例摄片发现有骨质破坏;淋巴结肿大7例,其中4例活检证实为转移癌;出血症7例,以皮肤紫癜多见,发烧6例呈持续低烧或不规则热;胸骨叩痛5例;周围血 WBC 低于正常2例,高于正常者6例.BPC 低于正常者6例.血片中发现幼稚粒和晚幼红细胞者5例.骨髓增生度不一,其中4例增生减低或重度减低,巨核细胞明显减少,粒系统下降.12例找到癌细胞,多聚集成团,形态多变,直径15～30μ,胞膜不清,胞浆丰富呈蓝色,有空泡形成,核染色质增粗,分布不均,核仁多样,少数可看到有丝分裂.
This article reports 13 cases of malignant tumor with bone marrow metastasis as the first result of misdiagnosis experience: 11 males and 2 females, aged 21 to 67. The appearance of bone marrow metastases (McBM) symptoms to the time of diagnosis: <1 month, 1 ~ 7 months in February, 5 cases in March ~ June, 12 cases were diagnosed after metastatic cancer cells in bone marrow smear, 1 case was confirmed by autopsy, 9 cases were found with primary tumor, including 5 cases of gastric cancer, 5 cases of colon cancer, breast cancer , 1 case of lung cancer and prostate cancer, 4 cases of unknown primary tumor Clinical manifestations: 13 cases of McBM anemia (27 ~ 98g / L), bone and joint pain in 8 cases, but only 1 case of film found in bone 7 cases of lymphadenopathy, of which 4 biopsy confirmed metastatic cancer; hemorrhagic disease in 7 cases of skin purpura more common, fever in 6 cases showed persistent fever or irregular heat; sternal percussion pain in 5 cases; peripheral blood WBC less than Normal in 2 cases, higher than the normal in 6 cases.BPC less than normal in 6 cases.While found in juvenile tablets and neonatal red blood cells in 5 cases.The degree of myeloproliferation varied, including 4 cases of reduced proliferation or severe reduction of megakaryocytes Significantly reduced, decreased granular system .12 cases of cancer cells found, clustered into groups, changing shape, diameter 15 ~ 30μ, cell membrane is unclear, abundant cytoplasm blue, vacuoles, nuclear chromatin Coarsening, uneven distribution, multiple nucleolus, a few can see mitosis.