Korkolopoulou P, Apostolidou E, Pavlopoulos P M, Kavantzas N, Vyniou N, Thymara I, Terpos E, Patsouris E, Yataganas X, Davaris P
Department of Pathology, University of Athens, Medical School, Greece.
Leukemia. 2001 Sep;15(9):1369-76. doi: 10.1038/sj.leu.2402220.
Considering the recently stated suggestion of neovascularization being implicated in myelodysplastic syndromes (MDS) pathogenesis, we evaluated multiple morphometric microvascular characteristics in MDS, in relation to clinicopathologic factors and prognosis. Trephines from 50 newly diagnosed MDS patients were immunostained for factor VIII and compared to those from 20 controls, 10 chronic myelomonocytic leukemia (CMML) and 12 acute myeloid leukemia (AML) patients. Quantitation of microvessel density (MVD), area, total vascular area (TVA), major and minor axis length, perimeter, compactness, shape factor, Feret diameter, and the number of branching vessels was performed by image analysis. Overall, the MDS group had significantly higher MVD, TVA, minor axis and shape factor values and significantly lower compactness than the control group. AML was characterized by increased vascularity compared to MDS and CMML, as well as by the presence of flattened microvessels (lower values of shape factor). Hypercellular MDS showed higher MVD. RA/RARS displayed larger caliber vessels than RAEB, which explains the favorable prognostic effect of increased size-related parameters on progression and/or survival. Moreover, decreased compactness and MVD were independent predictors of longer progression-free survival. It is concluded that angiogenesis is involved in the conversion of normal marrow to MDS and ultimately to AML and that disease progression within MDS is accompanied by qualitative alterations of the microvascular network. Furthermore, size-related parameters affect survival, while shape-related parameters and MVD are more influential with regard to progression-free survival.
考虑到最近提出的新生血管形成与骨髓增生异常综合征（MDS）发病机制有关的建议，我们评估了MDS中多个形态学微血管特征，并将其与临床病理因素及预后相关联。对50例新诊断的MDS患者的骨髓活检组织进行因子VIII免疫染色，并与20例对照、10例慢性粒单核细胞白血病（CMML）患者及12例急性髓系白血病（AML）患者的骨髓活检组织进行比较。通过图像分析对微血管密度（MVD）、面积、总血管面积（TVA）、长短轴长度、周长、致密性、形状因子、费雷特直径及分支血管数量进行定量分析。总体而言，MDS组的MVD、TVA、短轴及形状因子值显著高于对照组，致密性显著低于对照组。与MDS和CMML相比，AML的特征是血管增多，且存在扁平微血管（形状因子值较低）。细胞增多的MDS显示出较高的MVD。难治性贫血/难治性贫血伴环形铁粒幼细胞增多（RA/RARS）的血管口径大于难治性贫血伴原始细胞过多（RAEB），这解释了与大小相关参数增加对疾病进展和/或生存的有利预后影响。此外，致密性降低和MVD是无进展生存期延长的独立预测因素。得出的结论是，血管生成参与了正常骨髓向MDS并最终向AML的转化，且MDS内的疾病进展伴随着微血管网络的质性改变。此外，与大小相关的参数影响生存，而与形状相关的参数和MVD对无进展生存期的影响更大。
