B细胞型幼淋巴细胞白血病一例报道及回顾复习

A Case Report and Review of B-Cell Lymphoblastic Leukemia

摘要: 目的：提高对B细胞型幼淋巴细胞白血病(B-PLL)认识及诊断。方法：回顾分析本院一例B-PLL患者的临床表现、骨髓细胞形态学、流式细胞免疫分型、骨髓病理活检等临床资料，结合相关文献进行学习讨论，并与慢性淋巴细胞白血病(CLL)、T细胞幼淋细胞白血病(T-PLL)、毛细胞白血病等疾病进行鉴别诊断。结果：骨髓形态学：淋巴系异常增生，多为幼淋巴细胞，占87.0%，其胞体较大，呈圆形或椭圆形；胞浆量较多，呈蓝色或淡蓝色；核多呈圆形，可见凹陷，染色质较疏松，核仁大而明显，1~2个。流式细胞免疫分型：考虑为成熟B淋巴细胞增殖性疾病，慢性淋巴细胞白血病遗传学FISH检测5项均为阴性，排除其它淋巴增殖性疾病。综合患者骨髓形态学、临床表现及其它相关检查，考虑患者为B细胞幼淋细胞白血病。结论：外周血和骨髓中出现大量的幼淋巴细胞是确诊的B-PLL的必要条件，B-PLL的诊断主要依赖形态学结果、临床表现、免疫表型、遗传学等检查结果综合判定。

Abstract: Objective: To improve the recognition and diagnosis of B-cell lymphoblastric leukemia (B-PLL). Methods: The clinical manifestations, bone marrow cell morphology, flow cytometric immunotyping, bone marrow pathological biopsy and other clinical data of a B-PLL patient in our hospital were reviewed and discussed in combination with related literature, and the differential diagnosis was made with chronic lymphocytic leukemia (CLL), T cell lymphocytic leukemia (T-PLL), hair cell leukemia and other diseases. Results: Bone marrow morphology: Abnormal proliferation of CLL, mostly young lymphocyte, accounting for 87.0%, its cell body is large, round or oval, more cytoplasm, blue or light blue, nuclei are mostly round, visible concave, chromatin is loose, nucleolus is large and obvious, 1~2. Flow cytometry was considered as mature B lymphocyte proliferative disease. 5 genetic FISH tests for chronic lymphocytic leukemia were negative, and other lymphoproliferative diseases were excluded. Based on bone marrow morphology, clinical manifestations and other relevant examinations, the patient was considered to have B-cell lymphocytic leukemia. Conclusion: The presence of a large number of young lymphocytes in peripheral blood and bone marrow is the necessary condition for the diagnosis of B-PLL. The diagnosis of B-PLL mainly depends on the comprehensive evaluation of morphological results, clinical manifestations, immunophenotype and genetic results.