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首页> 外文期刊>Pathobiology: journal of immunopathology, molecular and cellular biology >Histopathology in the diagnosis and classification of acute myeloid leukemia, myelodysplastic syndromes, and myelodysplastic/myeloproliferative diseases.
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Histopathology in the diagnosis and classification of acute myeloid leukemia, myelodysplastic syndromes, and myelodysplastic/myeloproliferative diseases.

机译：诊断和分类急性髓性白血病，骨髓增生异常综合症和骨髓增生异常/骨髓增生性疾病的组织病理学。

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In spite of the impressive advances in the area of molecular pathology, bone marrow morphology remains the diagnosis cornerstone to identify the various subtypes of myeloid neoplasms. Morphological examination of the bone marrow requires both bone marrow aspirate and bone marrow trephine biopsy. Immunohistochemistry of bone marrow biopsy with markers reactive in paraffin-embedded tissues represents a powerful diagnostic tool; its results can be easily correlated with those obtained by other techniques such as flow cytometry and genetic analysis, and above all, the clinical findings. The role of the bone marrow biopsy will be particularly stressed in this review article. Particular emphasis is being given to the correct identification of cases of myeloid neoplasms associated with myelofibrosis and for which the bone marrow biopsy represents the only available diagnostic mean. Moreover, the often low cellular yield of the bone marrow aspirate in these cases may also be insufficient to obtain adequate cytogenetic information. Such cases include two subtypes of acute myeloid leukemia which typically cause diagnostic difficulties: acute megakaryoblastic leukemia and acute panmyelosis with myelofibrosis (acute myelosclerosis). Acute myeloid leukemia with multilineage dysplasia, therapy-related myelodysplastic syndrome/therapy-related acute myeloid leukemia and de novo myelodysplastic syndromes (MDS) will also be discussed. The value of bone marrow biopsy in this group of disorders is generally well established. In MDS, in particular, bone marrow biopsy may help in confirming a suspected diagnosis by excluding reactive conditions in which dyshematopoietic changes may also be observed. It can increase the diagnostic accuracy and helps in refining the IPPS risk evaluation system. Among the alterations detected by bone marrow biopsy, a prognostically important finding is the presence of aggregates or clusters of immature myeloid precursor cells (myeloblasts and promyelocytes). These can also be identified by immunohistochemistry with CD34, an antigen expressed in progenitor and early precursor marrow cells, which can be used to demonstrate pathological accumulations of blasts in aggressive subtypes of myeloid neoplasms. Immunohistologic analysis is especially helpful in cases of MDS with fibrosis and cases with hypocellular marrows (hypoplastic MDS). In both of these variants, the presence of reticulin fibrosis or fatty changes in the bone marrow can make accurate disease characterization very difficult or impossible using bone marrow aspirates. Finally, the important group of the myelodysplastic/myeloproliferative disorders can only be accurately categorized by a careful multiparametric approach in which the bone marrow biopsy exerts a pivotal role.
机译：尽管在分子病理学领域取得了令人瞩目的进步，但骨髓形态学仍是诊断髓系肿瘤各种亚型的诊断基石。骨髓的形态学检查需要同时进行骨髓穿刺活检和骨髓钙化活检。骨髓活检的免疫组织化学标记物在石蜡包埋的组织中具有反应性，是一种强大的诊断工具。它的结果可以很容易地与通过其他技术（例如流式细胞仪和遗传分析）获得的结果相关，最重要的是与临床发现相关联。这篇评论文章将特别强调骨髓活检的作用。特别强调正确识别与骨髓纤维化有关的骨髓瘤病例，而骨髓活检是唯一可用的诊断手段。此外，在这些情况下，骨髓抽吸物通常较低的细胞产量也可能不足以获得足够的细胞遗传学信息。此类病例包括通常引起诊断困难的两种急性髓性白血病亚型：急性巨核细胞白血病和伴有骨髓纤维化（急性骨髓硬化）的急性全骨髓病。还将讨论伴有多谱系异常增生，治疗相关的骨髓增生异常综合征/治疗相关的急性髓性白血病和新发骨髓增生异常综合征（MDS）的急性髓样白血病。在这一类疾病中，骨髓活检的价值通常是公认的。尤其是在MDS中，骨髓活检可以排除可能还观察到动态变化的反应性疾病，从而有助于确诊诊断。它可以提高诊断的准确性，并有助于完善IPPS风险评估系统。在骨髓活检发现的改变中，对预后重要的发现是存在未成熟的髓样前体细胞（成肌细胞和早幼粒细胞）的聚集体或簇。这些还可以通过用CD34免疫组织化学鉴定，CD34是在祖细胞和早期前体骨髓细胞中表达的抗原，可用于证明侵袭性亚型骨髓瘤中胚泡的病理性蓄积。免疫组织学分析对患有纤维化的MDS和具有骨髓下垂的患者（增生性MDS）尤其有用。在这两种变体中，骨髓中网状蛋白纤维化或脂肪变化的存在可能使使用骨髓穿刺物很难或不可能实现准确的疾病特征。最后，只有通过仔细的多参数方法才能对重要的一组骨髓增生异常/骨髓增生性疾病进行准确分类，在这种方法中，骨髓活检发挥了关键作用。

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