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Published on: April 15, 2022
[The morphology features of bone marrow in the prefibrotic-early primary myelofibrosis]
Xu-bo Gong1, Xiao-hong Zhang, Xing-guo Lu
1Department of Hematology, Zhejiang University, Hangzhou, China.
Objective:
To compare the morphologic features of bone marrow (BM) between the prefibrotic-early primary myelofibrosis (PMF) and essential thrombocythaemia (ET).
Method:
Seven cases of prefibrotic-early PMF were selected and analyzed. Based on the diagnostic standard of prefibrotic-early PMF by WHO, BM aspirate smears, trephine biopsy sections and imprints of 156 uncertain ET cases conducted simultaneously were recruited into this study, the BM morphologic features between the prefibrotic-early PMF and ET groups were analyzed. The morphological difference in 22 cases of prefibrotic-early PMF and 27 ET were compared between the JAK2V617F mutation positive and negative groups.
Results:
Of the 156 uncertain ET cases, it was reclassified 61 prefibrotic-early PMF (34 MF-0, 27 MF-1), 12 PMF and 83 ET. The platelet count and LDH level in MF-1 group were obviously higher than that of ET group (P < 0.05). The blast percentage of BM smear in MF-1 group was also higher than that of ET group (P < 0.05). As to BM section, cases with increased nucleated cells (granulocyte), compact megakaryocytic cluster, megakaryocyte near bone trabecula, cloud-like megakaryocyte, small bare nucleus of megakaryocyte and large ball-like megakaryocyte in MF-0 and MF-1 group were significantly higher than that of ET group (all P < 0.05), cases with megakaryocytic cluster of various size in MF-1 group were significantly higher than that of MF-0 and ET groups (P < 0.05). The JAK2V617F mutation rate in prefibrotic-early PMF and ET groups were 54.5% and 48.1%, respectively. Hb level in JAK2V617F mutation positive group was obviously higher than the negative group (P < 0.05), no special change with megakaryocytic morphology was found between the positive and negative groups.
Conclusion:
Morphology of BM section, especially megakaryocytic morphologic characteristics are the main basis in distinguishing prefibrotic-early PMF from ET. The importance of morphologic index were megakaryocytic cluster with various size, cloud-like megakaryocyte, large ball-like megakaryocyte, increased nucleated cells (granulocyte), small bare nucleus, megakaryocyte near bone trabecula and compact megakaryocytic cluster in order. JAK2V617F mutation provides no specific effect on the megakaryocytic morphology.
Insights
Bone marrow morphology, particularly megakaryocytic features, is key to distinguishing prefibrotic-early primary myelofibrosis (PMF) from essential thrombocythaemia (ET). These specific bone marrow (BM) changes aid in accurate diagnosis of these myeloproliferative neoplasms.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Distinguishing prefibrotic-early primary myelofibrosis (PMF) from essential thrombocythaemia (ET) is crucial for accurate diagnosis and management.
- Bone marrow (BM) morphology plays a vital role in the classification of myeloproliferative neoplasms.
Purpose of the Study:
- To compare the bone marrow (BM) morphologic features between prefibrotic-early primary myelofibrosis (PMF) and essential thrombocythaemia (ET).
- To identify key morphological differences that can aid in differentiating these two conditions.
Main Methods:
- Analysis of BM aspirate smears and trephine biopsy sections from seven prefibrotic-early PMF cases.
- Recruitment of 156 uncertain essential thrombocythaemia (ET) cases for comparative morphologic analysis.
- Comparison of morphological differences between JAK2V617F mutation-positive and negative groups in both prefibrotic-early PMF and ET.
Main Results:
- Sixty-one of 156 uncertain ET cases were reclassified as prefibrotic-early PMF.
- Significant differences in BM section morphology, including megakaryocytic characteristics (e.g., clusters, cloud-like, large ball-like forms) and increased nucleated cells, were observed between prefibrotic-early PMF and ET groups.
- JAK2V617F mutation rates were similar in both groups, with no specific effect on megakaryocytic morphology.
Conclusions:
- Bone marrow (BM) section morphology, especially megakaryocytic features, is the primary basis for distinguishing prefibrotic-early PMF from ET.
- Specific morphologic indices like megakaryocytic clusters, cloud-like megakaryocytes, and increased nucleated cells are important diagnostic markers.
- JAK2V617F mutation status does not appear to influence megakaryocytic morphology in these conditions.
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