CHUBU1215
·ì±Õ¼ðáçÉÂÍý³Ø

µÞÀ­µð³ËµåÀ­Çò·ìÉ¡¡acute megakaryoblastic leukaemia (M7)

WHO 4th ed. revised ¤ÎÄêµÁ*1¡§Aute myeloid leukemia, NOS¤Î°ì·¿¤Ç¤¢¤ëAcute megakaryoblastic leukemia. FABʬÎà¤ÎAML-M7

µÞÀ­Çò·ìɤΰ췿¤Ç20%°Ê¾å¤ËÁý¤¨¤¿²êµå¤Î¾¯¤Ê¤¯¤È¤âȾ¿ô(50%)¤¬µð³Ëµå·Ï¤Ç¤¢¤ë¤â¤Î¡£

MDS leukemia¤«¤é°Ü¹Ô¤·¤¿Îã¤ä, t(1;22)(p13;q13), inv(3)(q21;q26.2), t(3;3)(q21;q26.2)¤ò¤â¤ÄAMLÎã(AMKL¤Î·ì±ÕÁü¤ò¼¨¤¹), Down¾É¸õ·²´ØÏ¢¤Î¾ÉÎã¤Ï, ¤³¤Î¥«¥Æ¥´¥ê¡Ý¤Ë¤Ï´Þ¤Þ¤Ê¤¤¡£

  • t(1;22)(p13;q13): RBM15-MKL1
  • inv(3)(q21q26.2) or t(3;3)(q21;q26.2): RPN1 - EVI1
     
     

°Ê²¼3·²¤Î´µ¼Ô¤µ¤ó¤Ë, ¤ª¤Î¤ª¤Î°Û¤Ê¤Ã¤¿¥¿¥¤¥×¤ÎAMKL¤¬µ¯¤³¤ê¤¦¤ë.

1) Down¾É¤Î¾®»ù¡§WHOʬÎà¤ÇDown¾É¸õ·²´ØÏ¢¹ü¿ñÁý¿£À­¼À´µ(Myeloid proliferations associated with Down syndrome)¤È¤·¤ÆÆÈΩ¤·¤¿¼À´µ¤È¤µ¤ì¤ë.

2) Down¾É¸õ·²°Ê³°¤Î¾®»ù: Æý»ù¤Ç¤ÏÂçÉôʬ¤Î¾ÉÎ㤬WHOʬÎà¤ÎAML with t(1;22)(p13;q13); RBM15-MKL1¤ËÁêÅö. ǯĹ»ù¤Ç¤Ï, t(10;11); CALM-AF10, t(9;11), +8, +21¤Ê¤ÉÍÍ¡¹¤ÊÀ÷¿§ÂÎ, °äÅÁ»Ò°Û¾ï¤òȼ¤Ã¤¿¾ÉÎ㤬¸«¤é¤ì¤ë.

3) À®¿Í; ÆÃÄê¤Î°äÅÁ»Ò°Û¾ï¤Î¤ß¤é¤ì¤Ê¤¤¾ÉÎã(AML-NOS)¤¬Â¿¤¤. AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2); RPN1-EVl1¤Ç¤ÏAMKL¤ÎºÙ˦·ÁÂֽ긫¤ò¼¨¤¹¤³¤È¤¬¤¢¤ë.

AMKL-NOS

  • À÷¿§ÂÎ; -5, -7, +8, 11q ´ØÏ¢¤Î°Û¾ï¤Ê¤É¤¬Ç§¤á¤é¤ì¤ë.
     
  • Young adult¤Ë¤ª¤±¤ë½Ä³ÖæõºÙ˦¼ðáç¤ÈAMKL¹çÊ»Îã¤Ë¤Ï¤¤¤¯¤Ä¤«¤ÎÀ÷¿§Âΰ۾郎ÃΤé¤ì¤Æ¤¤¤ë. i(12p)¤¬ÆÃħŪ¤Ç¤¢¤ë.

AML with t(1;22)(p13;q13); RBM15-MKL1

  • RBM15-MKL1fusion¤Ë¤è¤êRBM15(RNA-binding motif protein-15; OTT¤È¤â¤è¤Ð¤ì¤ë)¤ÈMKL1(megakaryocyte leukemia-1; MAL¤È¤â¤è¤Ð¤ì¤ë)¤ÎÍ»¹ç¥­¥á¥é¥¿¥ó¥Ñ¥¯RBM15-MKL1(OTT-MAL)¤¬»ºÀ¸¤µ¤ì¤ë.
     
  • RBM15¤ÏHox¤Îµ¡Ç½¤äRas¥·¥°¥Ê¥ëÅÁã¤ÎÄ´Àá¤Ë¤«¤«¤ï¤ê, MKL1¤Ï¥¯¥í¥Þ¥Á¥ó¹½Ãۤ˴ØÏ¢¤¹¤ëDNA·ë¹ç¥â¥Á¡¼¥Õ¤ò¤â¤Ä.Í»¹ç°äÅÁ»Ò¤Ï¥¯¥í¥Þ¥Á¥ó¤Î¹½ÃÛ¤äHox¤ÇͶƳ¤µ¤ì¤ëʬ²½¤È¥·¥°¥Ê¥ëÅÁã¤Ë±Æ¶Á¤òÍ¿¤¨Çò·ìÉÂȯ¾É¤Ë´Ø¤ï¤ë²ÄǽÀ­¤¬¤¢¤ë.

ÉÂÍýÁÈ¿¥, ºÙ˦½ê¸«

Ëö¾¿·ì¤Îsmall megakaryoblast(micromegakaryoblast); ÃæÄøÅÙ¤ÎN/CÈæ, ºÙ˦¼Á¤Îbudding¡Ê½Ð²ê), ÈùºÙ¤ÊÌÖÌܾõ¥¯¥í¥Þ¥Á¥ó¤ò¤â¤Ä±ß·Á³Ë¤ò¤â¤Ä¡£
megakaryoblast¤Ï¿ºÌ¤Ê·ÁÂ֤Τ¿¤áµð³Ëµå·Ï¤Ç¤¢¤ë¤³¤È¤Î¾ÚÌÀ¤Ë, ¤·¤Ð¤·¤ÐÌȱÖÀ÷¿§¤¬É¬ÍפȤʤ롣CD41, CD42b, CD61À÷¿§ÍÛÀ­¤¬µð³Ëµå·Ï¤Î¾ÚÌÀ¤È¤Ê¤ë.

M7_01PB.jpg(199.6KB)¡¡¡¡M7_02PB.jpg(180.7KB) ¡¡

 

CD41(anti-GP­¶b)¤Ïµð³Ë²êµå¤ÎÍļå¤ÊÃʳ¬¤è¤ê¸¡½Ð¤µ¤ìÉÑÍѤµ¤ì¤ë¡£CD41(=platelet fibrinogen receptor alpha subunit)¤Ï·ì¾®ÈĶŽ¸¤ËɬÍפÊÅü¥¿¥ó¥Ñ¥¯.

¤¿¤À¤·CD41¤Ï¥Û¥ë¥Þ¥ê¥ó¸ÇÄê¥Ñ¥é¥Õ¥£¥óÁÈ¿¥¤Ë¤¦¤Þ¤¯Å¬±þ¤Ç¤­¤ë»ÔÈι³ÂΤ¬¤Ê¤¤¡£ÁÈ¿¥¤Ë¤ÏCD42b, CD61¤ò»È¤Ã¤Æ¤¤¤ë¡£FCM¤Ç¤ÏCD41¤¬»È¤ï¤ì¤ë.

·ì¾®ÈĤˤϡ¤10¼ïÎà°Ê¾å¤ÎÀÜÃåʬ»Ò¤¬Â¸ºß¤¹¤ë. ¤½¤Î¤¦¤ÁCD41(GP­¶b/­·a)¡¤CD42b(GP­µb¦Á)¤Ï, ·ì¾®ÈĤÀ¤±¤Ë¸ºß¤·¡¤Ç´Ãå(ºÙ˦-´ð¼Á)¡¤¶Å½¸(ºÙ˦-ºÙ˦)¤Ë¿¼¤¯´Ø¤ï¤Ã¤Æ¤¤¤ë·ì¾®ÈÄËìÅüÃÁÇò¤Ç¤¢¤ë.

  • CD41(GP­¶b/­·a)¤Ï·ì¾®ÈĤ¬»É·ã¤ò¼õ¤±¤Æ³èÀ­²½¤µ¤ì¤ë¤È¡¤¥ê¥¬¥ó¥É·ë¹çÉô°Ì¤¬Ïª½Ð¤·¥Õ¥£¥Ö¥ê¥Î¥²¥ó¥ì¥»¥×¥¿¡¼¤È¤·¤Æ¤Îµ¡Ç½È¯¸½¤¬Í¶Æ³¤µ¤ì¤ë.
  • CD42b(GP­µb¦Á)¤ÏÆâÈé²¼ÁÈ¿¥¤Ë´Þ¤Þ¤ì¤ë¥³¥é¡¼¥²¥ó¤Ë·ë¹ç¤·¤Æ¹½Â¤ÊѲ½¤òµ¯¤³¤·¤¿vWF¤Î¥ì¥»¥×¥¿¡¼¤È¤·¤Æ·ë¹ç¤¹¤ë
     
     

µð³Ë²êµåmegakaryoblast

  • Ä̾ï¤ÏÃæ·¿¤Ê¤¤¤·Âç·¿ºÙ˦¤Ç³Ë¤Ï±ß·Á, ¤Ê¤¤¤·¤ï¤º¤«¤ËÉÔÀ°·Á¡£³Ë¥¯¥í¥Þ¥Á¥ó¤Ï¾¤ÎAML²êµå¤ËÈæ¤Ù¤Æ¤è¤êÇ»½Ì¤·¤¿·¹¸þ¤ò¤·¤á¤¹¡£¤·¤Ð¤·¤Ð°Û·¿µð³Ëµå¤Î¤è¤¦¤ÊÀ®½Ï¤·¤¿½ê¸«¤òÄ褹¤ë¤³¤È¤¬¤¢¤ë¡£1-3¸Ä¤Î³Ë¾®ÂΤò¤â¤Ä¡£
     
  • À¸¸¡ÁÈ¿¥¤Ç¤â, ÆÃħ¤Î¤Ê¤¤²êµå¤«¤é°Û·¿µð³Ëµå¤È·ÁÂÖŪ¤ËƱÄê¤Ç¤­¤ëºÙ˦¤Þ¤Ç¤Î°Ü¹ÔÁü¤¬¤ß¤é¤ì¤ë¤³¤È¤¬¤¢¤ë¡£
     
  • ºÙ˦¼Á¤Ï¹¥±ö´ðÀ­¤Çðù㤬¸«¤é¤ì¤ë¤³¤È¤â¤¢¤ë¡£
     
  • ºÙ˦¼ÁÊÕ±ï¤Ï¤®¤¶¤®¤¶¤ÇºÙ˦ÆÍµ¯¤äµ¶Â­¤¬µð³Ë²êµå¤ÎÆÃħ¤Ë¤Ê¤ë¡£
     
  • ¤È¤­¤ËN/CÈæ¤¬¹â¤¤ºÙ˦¼Á¤Î˳¤·¤¤¾®·¿¤Î²êµå¤Ç¡¢¥ê¥ó¥Ñ²êµå¤È¤Î´ÕÊ̤¬º¤Æñ¤Ç¤¢¤ë¡£
     
  • ¹ü¿ñ¥¹¥á¥¢¤Çµð³Ë²êµå¤¬ºÙ˦²ô¤ò¤Ä¤¯¤ë¤è¤¦¤Ë¶Å½¸¤·Å¾°Ü¼ðáçºÙ˦¤Ë¤è¤¯»÷¤ë¤³¤È¤¬¤¢¤ë¡£
     
  • MPO, naphtolAS-DCAE, SudanB¤Ï¤Ä¤Í¤Ë±¢À­¡£
     
  • PASÀ÷¿§, AcP(acid phosphatase)À÷¿§¤¬ÍÛÀ­¤È¤Ê¤ë¤³¤È¤¬¤¢¤ë¡£
     
  • ÈóÆÃ°ÛŪ¥¨¥¹¥Æ¥é¡¼¥¼¤¬ºÙ˦¼Á¤ËÈÃÅÀ¾õ¤¢¤ë¤¤¤ÏÉôʬŪ¤ËÍÛÀ­¤Î¤³¤È¤¬¤¢¤ë¡£
 

¹ü¿ñÀ¸¸¡ÁÈ¿¥

M7_biopsyMG.jpg(211.8KB)

1. ²êµåÁýÀ¸¤ÎÃøÌÀ¤Ê¿ñÍÍÁÈ¿¥¤ò¤·¤á¤¹megakaryoblastic leukaemia¤È

2. ²êµå¤ÎÁý¿£¤¬Ë³¤·¤¯, myelofibrosis¤Î¤ß¤¬¤á¤À¤Ä£²¤Ä¤Î¥¿¥¤¥×¤¬¤¢¤ë¡£

  • ¹ü¿ñÀ¸¸¡ÁÈ¿¥½ê¸«¤Ï¿ºÌ¤ÊÁü¤ò¤·¤á¤¹¡£µÞÀ­¥ê¥ó¥ÑµåÀ­Çò·ìɤΤ褦¤ÊÁü¤«¤é¡¢Å¾°Ü¼ðáç¤Î¤È¤­¤Ë¸«¤é¤ì¤ë¤è¤¦¤Ê¹­ÈϰϤÊÀþ°Ý²½¤Þ¤Ç¤¢¤ë¡£°ìÈÌŪ¤Ë¤Ï¾®»ùÎã¤Ç¤ÏºÙ˦¤Ï°ìÍͤǤ¢¤ë¤³¤È¤¬ÂçÊÑ¿¤¤¡£
     
  • ¹ü¿ñÀþ°Ý²½¤Ï t(1;22)¤ò¤â¤Ä¿·À¸»ù acute megakaryoblastic leukaemia¤ËÆÃħŪ¤Ê¤â¤Î¤Ç¤Ï¤Ê¤¯µð³ËµåÀ®Ê¬¤ÎÃøÌÀ¤Ê¤É¤ÎÇò·ìɤˤâÉáÄ̤Ëǧ¤á¤é¤ì¤ë¡£
     
  • Àþ°Ý²½¤Ë¤è¤ê¡Êµð³Ë²êµå¤¬»ºÀ¸¤¹¤ëfactor¤Ë¤è¤ë¤È¿ä¬¤µ¤ì¤Æ¤¤¤ë)¹ü¿ñÀü»ÉµÛ°ú¤ÏÉÔÀ®¸ù¤Î¤³¤È¤¬Â¿¤¯, ¿ÇÃǤ˹ü¿ñÀ¸¸¡¤¬É¬ÍפȤʤ롣
     
  • ǯĹ»ù¤«¤éÀ®¿Í¤Îmegakaryoblastic leukaemia¤Ç¤Ï¿·ÏÅý¤Î°Û¾ï¤¬¤è¤¯Ç§¤á¤é¤ì¤ë¡£
     
  • myeloblast¤¬Áý¿£¤·Auer rod¤òǧ¤á¤ë¤³¤È¤¢¤ê¡£
     
  • ðùγµå·Ï¤·ì¤¬Ãø¤·¤¯°Û·Á¤Ê¤³¤È¤¬¤¢¤ê¡¢Æ±ÍͤËÀÖ²êµå·Ï¤Ë¤â°Û·ÁºÙ˦¤ÎÁý²Ã¤¬¤è¤¯Ç§¤á¤é¤ì¤ë¡£

phenotype

ÍÛÀ­¥Þ¡¼¥«:

  • CD41, CD61(µð³Ëµå¥Þ¡¼¥«), CD42b*1, CD34(À®½Ïµð³Ëµå¤ËÀ÷¤Þ¤ë¤³¤È¤¬¤¢¤ë), CD36, factor VIII.
  • ÍÛÀ­¤Ë¥Ð¥é¥Ä¥­¤¢¤ê; CD13, CD33, CD71, alpha naphthyl acetate esterase, PAS and HLA-DR
  • alpha-1-antitrypsin, alpha-1-antichymotrypsin, lysozyme¤¬¤Þ¤ì¤ËÍÛÀ­¤ò¼¨¤¹.*2

±¢À­¥Þ¡¼¥«:

  • Myeloperoxidase, Sudan Black B, CD14, CD64, glycophorin A
     
     

Case 01

70ºÐÂå¡¡½÷À­.
Aɱ¡¤Ë¤Æ, 4ǯÁ°¤ËÊ¢ÉôÂçÆ°Ì®²òÎ¥À­ÂçÆ°Ì®áî¤Ë¤è¤ê¿Í¹©·ì´ÉÃÖ´¹½Ñ»Ü¹Ô¤·°Ê¸å·Ð²á´Ñ»¡Ãæ. ÈÆ·ìµå¸º¾¯, ¿´ÉÔÁ´¤ÇÆþ±¡. Hb 5.7x104 WBC1370/¦Ìl, plt1.8x104. Ëö¾¿·ì²êµå¡Ü.
¹ü¿ñÀü»É¤Ïdry tap¤Ç¤¢¤Ã¤¿. ¾Ò²ð¤µ¤ì¹ü¿ñÀ¸¸¡¤ò¹Ô¤¦.

ASD01.jpg(184.5KB)ASD02.jpg(174.2KB)togin01ok.jpg(208.2KB)togin02ok.jpg(260.7KB)
ASD-Giemsa x40ASD-Giemsa x40ÅÕ¶ä x40ÅÕ¶ä x40
 
 

Acute panmyelosis with myelofibrosis (APMF)

WHO 2017 4th Ed¤ÎÄêµÁ

µÞÀ­¤ÎÈÆ¹ü¿ñÀ­Áý¿£¾Épanmyeloid proliferation¤Ç²êµå¤¬Áý²Ã¤·(¹ü¿ñ¤¢¤ë¤¤¤ÏËö¾¿·ìºÙ˦¤Î¡æ20%) ¹ü¿ñÀþ°Ý¾É¤ò¹çÊ»¤¹¤ë.

¡ü È¿Éü¤¹¤ë°äÅÁ»Ò°Û¾ï¤ò¼¨¤¹AML
¡ü Acute myeloid leukaemia with myelodysplasia-related changes
¡ü ¼£ÎÅ´ØÏ¢AML
¤¤¤º¤ì¤Ë¤â´Þ¤Þ¤ì¤º, ¾åµ­¥°¥ë¡¼¥×¤Î¤¤¤º¤ì¤Î¥¯¥é¥¤¥Æ¥ê¥¢¤âËþ¤¿¤µ¤Ê¤¤.

  • acute megakaryoblastic leukaemia(M7)¤ÈÎ×¾²Áü, ·ì±ÕÉÂÍý½ê¸«¤¬ÉôʬŪ¤ËOverlap¤¹¤ë.

APMF¤ÏÈó¾ï¤Ë¤Þ¤ì¤ÊAML¤Î°ì·ÁÂÖ¤Ç, de novo¤Î¼À´µ. ´ðËÜŪ¤Ë¤ÏÀ®¿Í¤Î¼À´µ¤Ç¤¢¤ë¤¬, ¾®»ù¤ÎÊó¹ð¤â¤¢¤ë.

¿ê¼å¤äÈèÏ«´¶¤ÇµÞ·ã¤Ëȯɤ¹¤ë. ¿¤¯¤Ï, ȯǮ¤ä¹üÄˤò¤­¤¿¤¹. Ä̾ïÁ´¿È¾õÂ֤ε޷ã¤Ê°­²½¤¬¤ß¤é¤ì¤ë.

ÈÆ·ìµå¸º¾¯¾É¤¬¾ï¤Ë½Ð¸½¤·, 磼ð¤Ïǧ¤á¤é¤ì¤Ê¤¤¤«¤´¤¯·ÚÅ٤Ǥ¢¤ë.

Ëö¾¿·ì

  • ¸²Ãø¤ÊÈÆ·ìµå¸º¾¯¾É¤òÄ褹¤ë.
  • ÀÖ·ìµå¤Ïanisopoikilocytosis¤Ï¤Ê¤¤¤«, ¤Þ¤ì. ¼ï¡¹¤ÎÄøÅÙ¤Îmacrocytosis¤¬Ç§¤á¤é¤ì¤ë. ÀÖ²êµå½Ð¸½¤Ï¤Þ¤ì¤Ëǧ¤á¤é¤ì¤ë¤¬, teardrop-shaped cells(dacrocytosis)¤Ï´Ñ»¡¤µ¤ì¤Ê¤¤.
  • ¹¥ÃæµåÁ°¶îºÙ˦, ²êµå¤¬¤·¤Ð¤·¤Ð½Ð¸½¤¹¤ë.
    ðùγµå·ÏºÙ˦¤Î°Û·ÁÀ®¤¬¹âÉÑÅ٤ˤߤé¤ì¤ë¤¬, AML with myelodysplasia-related changes¤Î¥¯¥é¥¤¥Æ¥ê¥¢¤Ë¤ÏŬ¹ç¤·¤Ê¤¤.
  • °Û¾ï¤Ê·ì¾®ÈĤ¬¤è¤¯Ç§¤á¤é¤ì¤ë.

¹ü¿ñ½ê¸«

  • ¹ü¿ñµÛ°ú¤Ï¤·¤Ð¤·¤Ð¤¦¤Þ¤¯¤¤¤«¤Ê¤¤(dry tap)¤¿¤á, ¹ü¿ñÀ¸¸¡¤ÈÌȱÖÀ÷¿§¤¬¿ÇÃǤËɬÍפǤ¢¤ë.
  • ²á·ÁÀ®¿ñ¤Ç, ¤Ó¤Þ¤óÀ­¤ÎÀþ°ÝÀ­´Ö¼Á¤¢¤ê. 3·ÏÅý¤·ìºÙ˦¤ÎÁý¿¤¬Ç§¤á¤é¤ì¤ë;panmyelosis¤È¤è¤Ó, ³Æ·ÏÅý¤ÎÁêÂÐŪÁý²ÃÅ٤Ϥ¤¤í¤¤¤í¤Ç¤¢¤ë.
  • ÆÃħŪ¤Ê½ê¸«¤Ï²êµå¤Î½¸äÈÁ㤬, ¹¥»ÀÀ­¤ÎºÙ˦¼Á¤ò¤â¤Ä¾®·¿Í¥°Ì¤Ê, °Û·ÁÀ®µð³Ëµå¤È¤È¤â¤Ëǧ¤á¤é¤ì¤ë¤³¤È¤Ç¤¢¤ë.
  • °Û·ÁÀ®Mgk¤ÏÄãʬÍճˤä ʬÍÕ¤·¤Ê¤¤¥¯¥í¥Þ¥Á¥ó¤ÎÁ¤ʳˤò¤â¤ÄºÙ˦¤È¤·¤Æ³Îǧ¤Ç¤­¤ë. microMgk¤¬Áý¤¨¤ë¤¬²êµå¤È¤Þ¤Á¤¬¤¨¤Æ¥«¥¦¥ó¥È¤·¤Ê¤¤¤³¤È¤¬ÂçÀڤǤ¢¤ë.
  • small/ microMgk¤Î³Îǧ¤Ë¤ÏPASÀ÷¿§¤ä, ÌȱÖÀ÷¿§ (CD42b, CD61, CD41¾)¤¬Í­ÍѤˤʤë.
  • APMF¤Î¹ü¿ñ²êµåÁý²Ã¤ÎÄøÅ٤Ϥµ¤Þ¤¶¤Þ¤Ç¤¢¤ë. Ãæ±ûÃÍ 22.5%¤È¤¹¤ëÊó¹ð¤¬¤¢¤ë. ¿¤¯¤ÎÎã¤Ç¤Ï20-25%.
  • ¹ü¿ñÀþ°Ý²½¤ÎÄøÅ٤⤵¤Þ¤¶¤Þ¤Ç¤¢¤ê, ÅÕ¶äÀ÷¿§¤Ç¹õ¿§¤ÎÁ¡ºÙ¤ÊÃÆÀ­Àþ°ÝÁý²Ã¤¬¸«¤é¤ì¤ë. 籸¶Àþ°ÝÁý¿¤ÏÃÆÀ­Àþ°ÝÁý²Ã¤Ë¤¯¤é¤ÙÉÑÅÙ¤¬Ä㤤.

immunophenotype ÌȱÖÀ÷¿§

ºÙ˦¤¬ºÎ¼è²Äǽ¤Ê¾ì¹ç¤Ï, ²êµå¤ÏCD34, C-KIT, CD33, CD13¤¬¼ï¡¹¤ÎÄøÅÙ¤ËÍÛÀ­¤ò¼¨¤¹. MPO¤ÏÄ̾ﱢÀ­¤Ë¤Ê¤ë.Naphtol-ASD-CAE¤âÉÔÀ÷.


*1 WHO blue book: Tumor of haematopoietic and lymphoid tissues pp162-165
*1  Orazi A, et al. Acute panmyelosis with myelofibrosis: an entity distinct from acute megakaryoblastic leukemia. Mod Pathol. 2005 May;18(5):603-14.PMID:15578075
*2  Vago JF, et al. Acute megakaryocytic leukemia with myeloid/monocytic differentiation. Am J Surg Pathol. 1987 Nov;11(11):883-9.PMID:3674284

źÉÕ¥Õ¥¡¥¤¥ë: filetogin02ok_s.jpg 89·ï [¾ÜºÙ] filetogin02ok.jpg 214·ï [¾ÜºÙ] filetogin01ok_s.jpg 81·ï [¾ÜºÙ] filetogin01ok.jpg 267·ï [¾ÜºÙ] fileASD02_s.jpg 83·ï [¾ÜºÙ] fileASD02.jpg 203·ï [¾ÜºÙ] fileASD01_s.jpg 91·ï [¾ÜºÙ] fileASD01.jpg 216·ï [¾ÜºÙ] fileTo-gin03ok_s.jpg 93·ï [¾ÜºÙ] fileTo-gin03ok.jpg 99·ï [¾ÜºÙ] fileTo-gin02_s.jpg 81·ï [¾ÜºÙ] fileTo-gin02.jpg 99·ï [¾ÜºÙ] fileTo-gin01_s.jpg 101·ï [¾ÜºÙ] fileTo-gin01.jpg 90·ï [¾ÜºÙ] fileTo-gin00_s.jpg 84·ï [¾ÜºÙ] fileTo-gin00.jpg 79·ï [¾ÜºÙ] fileM7_02PB_s.jpg 467·ï [¾ÜºÙ] fileM7_biopsyMG_s.jpg 432·ï [¾ÜºÙ] fileM7_biopsyMG.jpg 1800·ï [¾ÜºÙ] fileM7_01PB_s.jpg 447·ï [¾ÜºÙ] fileM7_01PB.jpg 2038·ï [¾ÜºÙ] fileM7_02PB.jpg 2004·ï [¾ÜºÙ]

¥È¥Ã¥×   º¹Ê¬ ¥Ð¥Ã¥¯¥¢¥Ã¥× ¥ê¥í¡¼¥É   °ìÍ÷ ñ¸ì¸¡º÷ ºÇ½ª¹¹¿·   ¥Ø¥ë¥×   ºÇ½ª¹¹¿·¤ÎRSS
Last-modified: 2020-10-17 (ÅÚ) 10:49:35 (138d)