Presented at the 1998 APIII Conference Return to 1998 Abstract Index
PARATRABECULAR BONE MARROW MORPHOLOGY (TOPOGRAPHIC ALTERATION) IN MYELODYSPLASTIC SYNDROMES (MDS)
University of Alabama at Birmingham
Department of Pathology
Birmingham, Alabama
Vishnu V. B. Reddy, MD
Background: Myeloid precursors are normally located in paratrabecular area, erythroid and megakaryocytes are found in more central regions of the bone marrows. In myelodysplastic syndrome, there is alteration of topography of bone marrow with shift of erythroid precursors and megakaryocytes to the paratrabecular location and myeloid precursors to the center of the marrow. A retrospective analysis of 300 bone marrow biopsies from myelodysplastic syndromes (early and advanced stages) was done and compared with 100 cases of non-MDS biopsies (metastatic workup, anemia and infections). The morphologic findings and topographic alteration are graded (mild, moderate and severe) on H&E stained biopsies. In selected cases, CD34, CD68, CD15 and myeloperoxidase (MPO) stains are done to further define and identify the cell clusters and document topographic alterations.
Results: The most significant changes are noted along the 100-micron wide area next to bony trabeculae. Almost all of the myelodysplastic syndromes showed some degree of topographic alteration with shift of erythroid precursors and megakaryocytes near the bony trabeculae. Early MDS (n=139) and late MDS (n=161) showed topographic alteration (mild, moderate and severe). Non MDS cases showed rare paratrabecular erythroid elements (7/100).
Conclusions: In summary, bone marrow biopsy examination and grading of topographic alteration can be helpful in making early diagnosis of myelodysplasia; especially, useful in cases where cytogenetic findings are non-contributory or negative.
