Morphologic and immunohistochemical evaluation of splenic hematopoietic proliferations in neoplastic and benign disorders.
Spleen is a common site of extramedullary hematopoiesis. Extramedullary hematopoiesis seen in non-neoplastic conditions can occasionally be extensive and raise concerns for a myeloid neoplasm. We compared the morphologic and immunohistochemical features of splenic hematopoietic proliferations seen in neoplastic myeloid disorders (eg chronic myeloproliferative disorders, myelodysplastic/myeloproliferative disorders and acute myeloid leukemias) to extramedullary hematopoiesis seen in a variety of reactive conditions. In all, 80 spleen specimens were reviewed. The presence of each marrow-derived lineage, dysplasia and immunohistochemical results were evaluated (CD34, CD117, myeloperoxidase, CD68, p53, TdT, CD42b and hemoglobin). Neoplastic hematopoietic proliferations in chronic myeloproliferative disorders are characterized by trilineage hematopoiesis with significant dysplasia in all cell lineages. Acute myeloid leukemia showed an increase in immature forms, which were highlighted by immunohistochemistry. Reactive extramedullary hematopoiesis showed variability in histologic features. Post-bone marrow transplant and thrombotic thrombocytopenic purpura/hemolytic-uremic syndrome spleens showed extramedullary hematopoiesis with some morphologic features of immaturity, which could simulate chronic myeloproliferative disorder. However, they lacked characteristic immunohistochemical features of neoplastic myeloid disorders such as positivity for CD34 or CD117.
O'Malley
Dennis P
DP
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. dpomalle@iupui.edu
Kim
Young S
YS
Perkins
Sherrie L
SL
Baldridge
LeeAnn
L
Juliar
Beth E
BE
Orazi
Attilio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology*; D019046:Bone Marrow Neoplasms / Q000378:metabolism / Q000473:pathology*; D049109:Cell Proliferation; D002648:Child; D002675:Child, Preschool; D006411:Hematopoiesis, Extramedullary; D006801:Humans; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000378:metabolism / Q000473:pathology*; D013154:Spleen / Q000378:metabolism / Q000473:pathology*
D014408:Biomarkers, Tumor