Sharma Pooja, Palta Anshu, Tahlan Anita, Kaur Manveen, Singh Ram
Department of Pathology, Government Medical College and Hospital, Chandigarh, India.
Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
J Lab Physicians. 2021 Aug 24;14(2):139-143. doi: 10.1055/s-0041-1732491. eCollection 2022 Jun.
Hypocellular bone marrow (BM) disorders comprise heterogeneous entities associated with peripheral cytopenias and decreased production of hematopoietic cells in BM. This study was undertaken to analyze immunohistochemical expression of CD34, CD117, and p53 in morphologically diagnosed patients of hypocellular BM (aplastic anemia [AA], hypocellular myelodysplastic syndrome [h-MDS], and hypocellular acute myeloid leukemia [h-AML]). BM specimens were obtained from patients presenting with pancytopenia/bicytopenia. On 30 patients diagnosed as hypocellular BM, immunohistochemistry (IHC) for CD34, CD117, and p53 was performed. BM cellularity was < 30% in all (100%) patients. Blast count was increased in h-MDS and h-AML. Features of dysplasia were noted in six (20%) patients. Out of these, three patients were diagnosed as h-MDS having bilineage/trilineage dysplasia, and the other three patients were of AA (11.5% patients) displaying only dyserythropoiesis. On IHC, percentage of BM CD34+ cells was increased in h-MDS+ h-AML (3.87 ± 0.86) as compared with AA (0.19 ± 0.15) and controls (0.81 ± 0.21), = 0.01. Percentage of BM p53+ cells was also increased in h-MDS+ h-AML (2.9 ± 2.07) as compared with AA and controls, which did not show any p53+ cells, = 0.0. No statistically significant difference was observed in the expression of CD117 in h-MDS+ h-AML (4.95 ± 3.40) compared with AA (4.49 ± 1.07), = 0.99. The study demonstrates the usefulness of CD34 and p53 immunoexpression as an important ancillary method in distinguishing various hypocellular BM disorders, especially h-MDS and AA. However, the role of CD117 remains unclear and needs to be evaluated further by larger studies.
低细胞性骨髓疾病包括与外周血细胞减少和骨髓造血细胞生成减少相关的异质性疾病。本研究旨在分析形态学诊断为低细胞性骨髓（再生障碍性贫血[AA]、低细胞性骨髓增生异常综合征[h-MDS]和低细胞性急性髓系白血病[h-AML]）患者中CD34、CD117和p53的免疫组化表达情况。
骨髓标本取自全血细胞减少/两系血细胞减少的患者。对30例诊断为低细胞性骨髓的患者进行了CD34、CD117和p53的免疫组化（IHC）检测。
所有（100%）患者的骨髓细胞比例均<30%。h-MDS和h-AML中的原始细胞计数增加。6例（20%）患者出现发育异常特征。其中，3例患者被诊断为具有双系/三系发育异常的h-MDS，另外3例为仅表现为红细胞生成异常的AA患者（占患者的11.5%）。免疫组化结果显示，与AA（0.19±0.15）和对照组（0.81±0.21）相比，h-MDS+h-AML中骨髓CD34+细胞百分比增加（3.87±0.86），P=0.01。与AA和对照组相比，h-MDS+h-AML中骨髓p53+细胞百分比也增加（2.9±2.07），而AA和对照组未显示任何p53+细胞，P=0.0。与AA（4.49±1.07）相比，h-MDS+h-AML中CD117的表达无统计学显著差异（4.95±3.40），P=0.99。
该研究表明，CD34和p53免疫表达作为区分各种低细胞性骨髓疾病，尤其是h-MDS和AA的重要辅助方法具有实用性。然而，CD117的作用仍不明确，需要通过更大规模的研究进一步评估。
