Nodulos linfoides medulares em pacientes portadores de sindrome mielodisplasicas : incidencia, caracterização morfologica, imunohistoquimica e associação com criterios clinico-laboratoriais, progressão da doença e sobrevida

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

Myelodysplastic syndromes (MDS) are a heterogeneous group of c10na! disorders characterised by abnormalities in proliferation and maturation of haemopoietic precursors resulting in cytopenias and a preleukaemic state. Bone marrow lYffiphoid nodules (LN) are usually considered to be a physiological feature, closelyrelated to age. In patients with MDS their clinical and biological meaning remain obscure. In the present study the presence of LN in bone marrow biopsy was investigated in 206 patients with MDS. The median age was 58.5 years (range 15-89). According to FAB classification, there were 129 RA, 29 RARS, 31 AREB/AREB-t, 11 Clv1ML,5 hyperfibrotic variants and 1 unc1assifiablecase. Single or multiple LN were present in 24.8% of the cases. Twentyfive specimens were evaluated with a panel of antibodies reactive on routinely processed, paraffin-embedded trephine biopsies: CD20, CD3, CD45RO and anti-bc1-2.Although most LN were centrally located (88.3%), well circumscribed and polYffiorphous, some were paratrabecular (3.9%) or ill defined (13.7%). An increase in reticulin fibres was observed in 51.1% of cases. CD20 positive cells were found in 23/25 (92.0%) of the cases in three distinct pattems: strong central, perinodular and faint diffuse. Positivity with CD3 and/or CD45RO was detected in 12/25 (48.0%) ofthe cases. In 15 patients only B (13 cases) or T cells (2 cases) could be detected whereas in 10 cases a mixture ofB and T cells was noted. Bc1-2 expression was positive in only 2 specimens. The incidence of LN in our MDS patients was unexpectedly high considering the median age of patients. The comparison between patients with and without LN did not reveal statistically significant differences concerning age, sex, neutrophil counts, platelets, FAB subtype, disease progression or overall survival. The presence of LN showed a relationship with an increase in reticulin fibres in the OOematopoietic tissue (p=0.01), and patients with LN exhibited lower haemoglobin values (p=0.03). Multivariate survival analysis showed tOOtOOemoglobinand FAB subtype were the most significant predictors of survival. Our results show that LN in MDS patients OOveheterogeneous characteristics. No association with IYffiphoproliferative disease and no correlation with prognosis were found. These aggregates could be an expression of reactivity to an ongoing persistent and abnormal immune stimulation and are probably related to an altered bone marrow microenvironrnent

ASSUNTO(S)

imunohistoquimica medula ossea

ACESSO AO ARTIGO

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