期刊
HISTOPATHOLOGY
卷 56, 期 6, 页码 758-767出版社
WILEY
DOI: 10.1111/j.1365-2559.2010.03545.x
关键词
chronic myeloproliferative neoplasm; histopathology; thrombocytosis; WHO classification
Aims: To evaluate the feasibility of the histopathological diagnosis of prefibrotic-early primary myelofibrosis (PM) as described in the World Health Organization (WHO) classification and to evaluate the clinical implications of prefibrotic-early PM in a series of patients previously diagnosed as having essential thrombocythemia (ET) according to the Polycythemia Vera Study Group criteria. Methods and results: WHO criteria were applied to bone marrow biopsy specimens by two pathologists who then reclassified 127 cases as 102 ET (80.3%), 18 prefibrotic-early PM (14.2%) and seven fibrotic PM (5.5%). In 45 cases (35%), the final diagnosis was only reached by consensus. The megakaryocytic criteria that best discriminated between ET and prefibrotic-early PM were an increased nucleo-cytoplasmic ratio, presence of cloudlike nuclei, hyperchromatic-dysplastic nuclei, paratrabecular megakaryocytes and tight clusters. A histological score discriminated between ET (score < 3) and PM (score >= 6), but 21 cases showed an intermediate ambiguous score. No significant differences were observed at diagnosis and at follow-up (median time 93 months) for thrombosis, major haemorrhage, laboratory data, transformation into overt myeloid metaplasia and survival. Conclusions: The distinction between ET and prefibrotic-early PM is impaired by subjectivity in pathological practice and is of questionable clinical relevance, at least when considering individual patients.
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