Reactive Fibrosis

The MPDs, characterized by expansion of some or all hematopoietic cell lines, are also associated with reactive proliferation of mesenchymal cells, including fibroblasts and osteoblasts. Proliferation of fibroblasts leads to increased retic-ulin fibers, collagen, and fibrous tissue deposition in the medullary cavity (myelofibrosis) whereas osteoblastic proliferation results in bone (osteoid) deposition in the bone marrow (osteosclerosis or osteomyelosclerosis). Reactive myelofibrosis has also been noted in non-MPD diseases, including autoimmune conditions,48 hairy cell leukemia,49 acute leukemia,50 especially acute megakaryoblastic leukemia (FAB M7),51 malig

Table 3-

-2. FAB Classification of the Myelodysplastic

Syndromes

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