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7/12/2010 9:06:27 AM

D_Novak
D_Novak
Posts: 1 		We get quite a few bone marrow biopsies done at our hospital for unexplained cytopenia. Obvious dysplasia is seen in a few cases and in which I am comfortable calling it myelodysplasia. But in some cases the dysplasia is minimal and I don’t make the calls but clinicians strongly suspect MDS. Almost all of those cases have normal cytogenetics. Sometimes, we repeat the bone marrow biopsy for development of overt dysplasia. My question is can we call involvement by refractory anemia with only mild dyserythropoiesis and normal cytogenetics?
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7/12/2010 12:42:04 PM

Hanif
Hanif
Posts: 2 		D_Novak wrote:
We get quite a few bone marrow biopsies done at our hospital for unexplained cytopenia. Obvious dysplasia is seen in a few cases and in which I am comfortable calling it myelodysplasia. But in some cases the dysplasia is minimal and I don’t make the calls but clinicians strongly suspect MDS. Almost all of those cases have normal cytogenetics. Sometimes, we repeat the bone marrow biopsy for development of overt dysplasia. My question is can we call involvement by refractory anemia with only mild dyserythropoiesis and normal cytogenetics?


My threshold for MDS diagnosis is a little bit high. I donot diagnose MDS just on pancytopenia and mild dysplasia. There are diagnostic criteria in WHO. With no cytogenetic abnormality, I diagnose as "Hypocellular/Hypercellular bone marrow with erythroid or myeloid dysplasia".

Hanif
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7/12/2010 11:27:29 PM

Kaleem
Kaleem
Posts: 1 		The diagnosis of MDS in the absence of significant dysplasia is often challenging. The clinicians are not happy with a descriptive diagnosis because such a diagnosis does not provide any meaningful answer to their question. But at the same time there are limitations to which a pathologist can make a definitive diagnosis. This difficulty happens most often in cases of refractory anemia and not other categories. If I find more than "occasional" red cell precursors with "real" dysplastic changes I make the diagnosis of refractory anemia on morphologic grounds in an appropriate clinical context and supporting lab findings. Most of the times cytogenetics comes back clonal.
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