For a comprehensive evaluation, a bone marrow biopsy was also performed to evaluate the pancytopenia that showed cellular and left shift erythropoiesis, megaloblastoid
changes, and left shift granulopoiesis.
All cases of MDS showed dysplastic features, mainly in the form of megaloblastoid
While not always statistically significant, certain features were more common in CVD than in the control group (Figure), including (1) abnormal bony trabeculae, (2) megaloblastoid changes in the erythroid lineage, (3) sea-blue histiocytes (SBHs), and (4) ALIP of the granulocytic lineage.
In the erythroid lineage, we found significant Megaloblastoid change in a number of cases, but again, did not note other significant dysplastic features such as nuclear budding, multinucleation, or ring sideroblasts.
(%) of cases with: Lymphoid aggregates 10 (40) 16 (42) Pseudo-MPD 0 (0) 1 (3) Abnormal bone 8 (32) 13 (34) Sea-blue histiocytes 4 (16) 1 (3) Lipogranulomas 2 (8) 2 (5) Megaloblastoid erythroid lineage 9 (36) 10 (26) ALIP 7 (28) 5 (13) All Other CVDs Controls Total No.
In bone marrow, megaloblastoid
changes, multinuclearity, nuclear budding and bridging in erythroblasts, hypogranulation in granulocytic series, micromegakaryocytes, uninucleated and binucleated forms, and cytoplasmic vacuolation in megakaryocytes were the common dysplastic features.
Erythroid precursors occasionally reveal megaloblastoid nuclear maturation.
Megaloblastoid erythropoiesis with abnormal nuclear division (dyskinesis) and ringed sideroblasts are also present (Slides 5c, 5d, respectively).
The bone marrow was predominantly hyper cellular with megaloblastoid
changes in the erythroid series, large band forms and metamyelocytes (Figure 2,3).
Findings of dysplasia include 1 or more of the following: abundant megaloblastoid
forms, nuclear budding, bizarre nuclear shapes, multinucleation, foamy cytoplasmic vacuoles, or cytoplasmic pseudopods (Figure 2, A and B).
Dysplasia Findings Diagnosis 1 RBC: megaloblastoid
, 65% RS; t-MDS Meg: small, hypolobated 2 RBC: nuclear irregularity and t-MDS karyorrhexis, cytoplasmic vacuolization, 8% RS; Myeloid: nuclear atypia, cytoplasmic hypogranularity and vacuolization, pseudo-Pelger-Huet nuclei; Meg: small, hypolobated, clustered 3 RBC: megaloblastoid
, nuclear budding, t-AML arising cytoplasmic vacuoles, 52% from t-MDS nucleated RBC precursors Myeloid: blasts with rare granules, no Auer rods Meg: small, hypolobated, clustered Case No.