粟粒結核症の診断における連続切片による骨髄病変の検出の意義 : 倍検骨髄の病変からみた骨髄吸引, 骨髄生検材料の有用性 [in Japanese] Detection of Lesions in Bone Marrow for the Diagnosis of Miliary Tuberculosis : Reliebility of Bone Marrow Aspiration and Biopsy in View of Distribution Pattern of Lesions in Autopsy Cases [in Japanese]
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粟粒結核症の骨髄吸引・生検, さらに剖検症例の骨髄標本を再検討し, 吸引・生検の有用性を見るとともに, 特に骨髄標本からの診断率の向上を目的としてその評価法, 骨髄内病変分布について検討した.6例の粟粒結核症より採取した骨髄吸引 (4例)・生検 (4例) 検体において, 最初に作製した3枚の連続切片の陽性例は, 吸引は2例 (2/4), 生検は0例 (0/4) であった.さらに陰性例を, 30～40枚の連続切片を作製し検討したところ, 新たに吸引2例, 生検2例で陽性所見を認め, 最終的にはいずれか一方の陽性所見が得られ, 陽性率は100%で, 陽性率の向上を認めた.次に12例の剖検症例で椎体骨髄標本を検討し, 10例 (83%) に骨髄内肉芽腫を認めた.この内9例において, 椎体を中央部と辺縁部に分け比較した.辺縁部は中央部に比して肉芽腫形成が多く, 6例が辺縁部に中央部に比し2倍以上の分布を示した.残りの3例も辺縁部に多く, 骨髄吸引・生検において肉芽腫は採取されやすく診断に有用なものと考えられた.
The usefulness of the serial section method was investigated in four bone marrow aspirates, four biopsies and nine autopsy specimens obtained from patients with miliary tuberculosis who were admitted to our hospital between 1974 and 1994. In original sections, granulomas consistent with tuberculosis were found in two out of four aspirate specimens (50%) but in none of the four bone marrow biopsies. By using serially out sections, however, granulomas were detected in two more aspirate specimens and two biopsies which were negative in original sections. Consequently four of four aspirates (100%) and two of four biopsies (50%) became positive. In addition, the distribution of granulomas was investigated using vertebral bone marrows obtained from 12 autopsy cases. We divided the vertebral bone marrows obtained from 12 autopsy cases. We divided the vertebra into the peripheral and central portions. Granulomas were more frequently found in the peripheral portions than in the central.<BR>The higher detection rate of granulomas in the peripheral bone marrow when the biopsy and aspiration needles easily reach, suggests that bone marrow aspiration and/or biopsy would be a useful procedure for the diagnosis miliary tuberculosis. Therefore if serial sections were utilized for such samples in the miliary tuberculosis patients, the detection rate is expected to became much higher.
- Kansenshogaku Zasshi
Kansenshogaku Zasshi 70(9), 963-969, 1996-09-20
The Japanese Association for Infectious Diseases