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Pathohistological characteristics of myelodysplastic syndromes: Diagnostic and prognostic significance

Marisavljević Dragomir (Institut za hematologiju, Klinički centar Srbije, Beograd)
Čemerikić Vesna (Institut za hematologiju, Klinički centar Srbije, Beograd)
Rolović Zoran (Institut za hematologiju, Klinički centar Srbije, Beograd)
Bošković Darinka (Institut za hematologiju, Klinički centar Srbije, Beograd)
Čolović Milica (Institut za hematologiju, Klinički centar Srbije, Beograd)

INTRODUCTION Pathohistological (PH) analysis is recommended as basic diagnostic procedure during the investigation of myelodysplastic syndromes (MDS). AIM The aim of this paper was to investigate diagnostic and prognostic significance of bone marrow PH features in patients with MDS, and its relation to cytoiogical characteristics of bone marrow aspirate. METHODS Cellularity, disorder of marrow histotopography, quantity of hematopoiesis lineages, cellular atypia, the amount of myeloblasts, and stromal changes were particularly analyzed in trephines of 236 patients with primary MDS. RESULTS In most cases (78.4%) hypercellular bone marrow was observed, although in 10.2% patients hypocellular subtype of MDS was diagnosed. Erythropoiesis dislocation was present in 64.7% patients, dislocation of MK-poiesis in 50.9% patients, while 61.3% had dislocation of granulopoesis (so-called ALIP phenomenon). In most cases three lineage hyperplasia was present, while relative hypoplasia of E- and MK-lineage was found in1/4 cases, each, particularly in advanced MDS. Morphological features of dyseritropoiesis and dysmegakaryocytopoiesis were present in 42.5% and 75.7% cases, respectively. Different stages of reticulin and collagen fibrosis were observed in 55.5% patients, while 7.6% had hyperfibrotic subtype of MDS. Comparative analysis of cytoiogical and histological features of MDS bone marrow showed positive correlation between two methods only in respect of estimation of eritropoiesis quantity, presence of dismegakaryocytopoiesis and „reactive" cells. The univariate analysis showed that MK- and G-lineage dislocation, quantity of E- and G-lineage, and presence of dysmegakaryocytopoiesis, were prognostic indicators for short survival and evolution of the disease in MDS patients. However, multivariate analysis showed that only G-lineage dislocation was independent prognostic variable for survival in MDS cases. CONCLUSION PH analysis is irreplaceable diagnostic procedure during MDS investigation, since it provides reliable information of cellularity, architectural disorganization, number of megakaryocytes and alterations of marrow stroma. In addition, PH analysis provides numerous important prognostic information.

Keywords: myelodysplastic syndromes, pathohistological features, bone marrow, prognosis