title: Differential diagnosis of myelofibrosis based on WHO 2008 criteria: acute panmyelosis with myelofibrosis, acute megakaryoblastic leukemia with myelofibrosis, primary myelofibrosis and myelodysplastic syndrome with myelofibrosis.
abstract: BACKGROUND
  The aim of this study was to characterize clinicopathological features of acute panmyelosis with myelofibrosis (APMF), acute megakaryoblastic leukemia with myelofibrosis (AMKL-MF), primary myelofibrosis (PMF) and myelodysplastic syndrome with myelofibrosis (MDS-MF) in order to provide the keys to the differential diagnosis of bone marrow (BM) fibrosis.
  
  
  METHODS
  We compared age, gender, splenomegaly, serum lactate dehydrogenase level, blood cell counts, blast counts in peripheral blood (PB) and BM, megakaryocyte counts, BM cellularity, dysplasia, and the karyotypes of patients with APMF (n = 6), AMKL-MF (n = 7), PMF (n = 44), and MDS-MF (n = 44).
  
  
  RESULTS
  APMF showed hyperplasia of all three lineages, increase in megakaryocyte count with dysplasia and frequent abnormal karyotypes. AMKL-MF was associated with elevated BM blast counts, decreased BM megakaryocyte count with rare megakaryocytic dysplasia and chromosome 21 abnormality. PMF patients displayed splenomegaly, rare blasts in PB/BM, and JAK2 V617F mutation. MDS-MF patients showed pancytopenia, dysplasia in all three lineages and recurrent chromosomal abnormalities involving chromosome 5,7,12, and 17.
  
  
  CONCLUSIONS
  Although differential diagnosis among APMF, AMKL-MF, PMF, and MDS-MF is very challenging due to the overlapping clinical and morphological features, meticulous investigation of the patient with respect to splenomegaly, blood cell count, PB and BM findings, and karyotype will serve as a guide to correct diagnosis.
authors.affiliation: Department of Laboratory Medicine, VHS Medical Center, Seoul, South Korea; Department of Laboratory Medicine, College of Medicine and Asan Medical Center, University of Ulsan, Seoul, South Korea.
authors.forename: E
authors.initials: E
authors.lastname: Bae
authors.forename: C-J
authors.initials: CJ
authors.lastname: Park
authors.forename: Y-U
authors.initials: YU
authors.lastname: Cho
authors.forename: E-J
authors.initials: EJ
authors.lastname: Seo
authors.forename: H-S
authors.initials: HS
authors.lastname: Chi
authors.forename: S
authors.initials: S
authors.lastname: Jang
authors.forename: K-H
authors.initials: KH
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: J-J
authors.initials: JJ
authors.lastname: Suh
authors.forename: H-J
authors.initials: HJ
authors.lastname: Im
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007621:Karyotyping; D007947:Leukemia, Megakaryoblastic, Acute / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D055728:Primary Myelofibrosis / Q000097:blood / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D055815:Young Adult
keywords: Myelofibrosis; acute megakaryoblastic leukemia; acute panmyelosis with myelofibrosis; myelodysplastic syndrome; primary myelofibrosis