Bone Marrow Histology

MDS is characterized by architectural disorganization. Therefore, a bone marrow biopsy provides useful information on cellularity, relative proportions of three hematopoietic cell lines, architectural disorganization, and increase in the reticulin fibers. Architectural disorganization affects the spatial localization of the hematopoietic cells so that erythroblasts and megakaryoblasts are found at the trabecular surface. Moreover, small clusters of blast cells may be identified in central marrow regions referred to as abnormal localization of immature precursors (ALIP) (Plate 14-25). Tricot et al.167 showed that patients presenting with ALIP experienced early leukemic transformation and short survival irrespective of FAB type. Prognostic significance of ALIP was also confirmed by several other studies.168 However, it is difficult to distinguish ALIP from immature aggregates of normal marrow precursor cells on H & E or Giemsa-stained sections. However, immunohistochemistry can easily be confirmed by both the presence and lineage of these immature cells.169

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