Megakaryocytes in chronic phase of chronic myeloid leukemia: A descriptive case series
Keywords:
Chronic myeloid leukemia, megakaryocytes, micromegakaryocytes, bone marrow fibrosis.
Abstract
Background: Megakaryocytic proliferation and functional alterations are frequently observed in various myeloproliferative neoplasms (MPN). An analysis of these alterations provides clue to the diagnosis of MPN such as essential thrombocythemia and myelofibrosis. We in our descriptive study have tried to evaluate and identify the morphological features of the megakaryocytes seen in chronic myeloid leukemia- chronic phase (CML-CP).Methods: Bone marrow aspirate and trephine biopsy from 31 newly diagnosed cases of CML-CP were evaluated for the morphological parameters including count, distribution, clustering, cytoplasmic granularity, nuclear lobes, micromegakaryocytes, fragmented nuclei, bare nuclei, and emperipolesis. All the cases were also evaluated for marrow reticulin fibrosis Result: Megakaryocytic count was increased in 58% of cases (18 out of 31), 67.7% had parasinusoidal distribution, 67.7% had no megakaryocytic clusters. Hypolobation of nuclei and presence of micromegakaryocytes were consistent findings in all the cases. The megakaryocyte count showed a positive correlation with the grade of marrow reticulin fibrosis and peripheral blood platelet count.Conclusion: Characteristic changes in megakaryocyte number, distribution and morphological features is seen in CML-CP and may help in differentiating it from other MPN’s.References
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14. Wong KF, Chan JK. Are dysplastic and hypogranular megakaryocytes specific markers for myelodysplastic syndrome? Br J haematol 1991; 77:509-514.
15. Bobik R, Podolak-Dawidziak M, Kiełbiński M, Jeleń M, Wróbel T.Emperipolesis in megakaryocytes in patients with thrombocytosis in the course of myeloproliferative disorders. Acta Haematol Pol 1995;26(2):179-83.
16. Cashell AW, Buss DH. The frequency and significance of megakaryocytic emperipolesis in myeloproliferative and reactive states. Ann Hematol Jun 1992; 64(6):273-6.
17. Lazzarino M, Morra E, Castello A, et al. Myelofibrosis in chronic granulocytic leukaemia: clinicopathologic correlations and prognostic significance. Br J Haematol 1986;64:227-40.
18. Buhr T, Georgii A, H. Myelofibrosis in chronic myeloproliferative disorders. Incidence among subtypes according to the Hannover Classification. Choritz Pathol Res Pract 1993; 189:121-32.
19. Papadantonakis N, Matsuura S, Ravid K. Megakaryocyte pathology and bone marrow fibrosis: lysyl oxidase connection. Blood 2012;120(9):1774-8
2. Georgii A, Buesche G, Kreft A. The histopathology of chronic myeloproliferative diseases. Baillieres Clin Haematol Dec 1998; 11(4):721-49.
3. BatesI, Burthem J. Bone Marrow Biopsy. In: Bain BJ, Bates I, Laffan MA, Lewis SM, editors Dacie and Lewis Practical Hematology. 11th ed. London:Churchill Livingstone Elsevier; 2012.123-137
4. Bain BJ, Lewis SM. Preparation and Staining Methods for Blood and Bone Marrow Films. In: Bain BJ, Bates I, Laffan MA, Lewis SM, editors Dacie and Lewis Practical Hematology. 11th ed. London:Churchill Livingstone Elsevier; 2012.57-68
5. Jones LM, Bancroft JD, Gamble M. Connective Tissues and Stains. In: Bancroft JD, Gamble M, editors Bancroft’s Theory and Practice of Histological Techniques. 6th ed. Churchill Livingstone Elsevier; 2007.135-160.
6. Muhury M, Mathai AM, Rai S, Naik R, Pai MR, Sinha R. Megakaryocytic alterations in thrombocytopenia: A bone marrow aspiration study. Indian J Pathol Microbiol 2009; 52(4):490-4.
7. Thiele J, Kvasnicka HM, Faccheti F, Franco V, Walt JV, Orazi A. European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica 2005; 90(8):1128-32.
8. Khonglah Y, Basu D, Dutta TK. Bone marrow trephine biopsy findings in chronic myeloid leukemia. Malays J Pathol 2002; 24(1):37 - 43.
9. Bartl R, Frisch B, Wilmanns W. Potential of bone marrow biopsy in chronic myeloproliferative disorders. Eur J Haematol 1993; 50(1):41-52.
10. Kaloutsi V, Fritsch RS, Buhr T, Restrepo-Specht I, Widjaja W, Georgii A. Megakaryocytes in chronic myeloproliferative disorders: numerical density correlated between different entities. Virchows Arch A Pathol Anat Histopathol 1991; 418(6):493-7.
11. Nafe R, Holgado de Colombo S, Choritz H, Georgii A. Morphometry of megakaryocytes for supporting the histologic diagnosis of chronic myeloproliferative diseases. The Pathologist 1995;16(1):34-40.
12. Thiele J, Quitmann H, Wagner S, Fischer R. Dysmegakaryopoiesis in myelodysplastic syndromes (MDS): An immunomorphometric study of bone marrow trephine biopsy specimens. J Clin Pathol 1991; 44:300-305.
13. Michiels JJ. Diagnostic criteria of the myeloproliferative disorders (MPD): essential thrombocythaemia, polycythaemia vera and chronic megakaryocytic granulocytic metaplasia. Neth J Med 1997 Aug; 51(2):57-64.
14. Wong KF, Chan JK. Are dysplastic and hypogranular megakaryocytes specific markers for myelodysplastic syndrome? Br J haematol 1991; 77:509-514.
15. Bobik R, Podolak-Dawidziak M, Kiełbiński M, Jeleń M, Wróbel T.Emperipolesis in megakaryocytes in patients with thrombocytosis in the course of myeloproliferative disorders. Acta Haematol Pol 1995;26(2):179-83.
16. Cashell AW, Buss DH. The frequency and significance of megakaryocytic emperipolesis in myeloproliferative and reactive states. Ann Hematol Jun 1992; 64(6):273-6.
17. Lazzarino M, Morra E, Castello A, et al. Myelofibrosis in chronic granulocytic leukaemia: clinicopathologic correlations and prognostic significance. Br J Haematol 1986;64:227-40.
18. Buhr T, Georgii A, H. Myelofibrosis in chronic myeloproliferative disorders. Incidence among subtypes according to the Hannover Classification. Choritz Pathol Res Pract 1993; 189:121-32.
19. Papadantonakis N, Matsuura S, Ravid K. Megakaryocyte pathology and bone marrow fibrosis: lysyl oxidase connection. Blood 2012;120(9):1774-8
Published
2016-08-12
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