Immunoexpression of CD34, CD117, and p53 in Hypocellular Bone Marrow Disorders

Abstract

Objectives Hypocellular bone marrow (BM) disorders comprise heterogeneous entities associated with peripheral cytopenias and decreased production of hematopoietic cells in BM. This study was undertaken to analyze immunohistochemical expression of CD34, CD117, and p53 in morphologically diagnosed patients of hypocellular BM (aplastic anemia [AA], hypocellular myelodysplastic syndrome [h-MDS], and hypocellular acute myeloid leukemia [h-AML]). Materials and Methods BM specimens were obtained from patients presenting with pancytopenia/bicytopenia. On 30 patients diagnosed as hypocellular BM, immunohistochemistry (IHC) for CD34, CD117, and p53 was performed. Results BM cellularity was < 30% in all (100%) patients. Blast count was increased in h-MDS and h-AML. Features of dysplasia were noted in six (20%) patients. Out of these, three patients were diagnosed as h-MDS having bilineage/trilineage dysplasia, and the other three patients were of AA (11.5% patients) displaying only dyserythropoiesis. On IHC, percentage of BM CD34+ cells was increased in h-MDS+ h-AML (3.87 ± 0.86) as compared with AA (0.19 ± 0.15) and controls (0.81 ± 0.21), p = 0.01. Percentage of BM p53+ cells was also increased in h-MDS+ h-AML (2.9 ± 2.07) as compared with AA and controls, which did not show any p53+ cells, p = 0.0. No statistically significant difference was observed in the expression of CD117 in h-MDS+ h-AML (4.95 ± 3.40) compared with AA (4.49 ± 1.07), p = 0.99. Conclusion The study demonstrates the usefulness of CD34 and p53 immunoexpression as an important ancillary method in distinguishing various hypocellular BM disorders, especially h-MDS and AA. However, the role of CD117 remains unclear and needs to be evaluated further by larger studies.

Diagnostic Value of CD34 and CD117 Immunohistochemistry and Megakaryocyte Morphology in Myelodysplastic Syndromes: A Retrospective Case-control Study

“…13 The percentage of CD34+ cells in normal BMB does not exceed 1%, whereas abnormalities in both percentage and distribution of positive cells have been observed in MDS patients who have a tendency towards forming aggregates. 7,[14][15][16][17] Similarly, the high proportion of CD34+ cells and the high number of CD34 aggregates also can be observed in AML patients. 18 Sharma et al 7 reported that immunoexpression of CD34 was decreased in 25 (96.2%) patients of AA.…”

“…7,[14][15][16][17] Similarly, the high proportion of CD34+ cells and the high number of CD34 aggregates also can be observed in AML patients. 18 Sharma et al 7 reported that immunoexpression of CD34 was decreased in 25 (96.2%) patients of AA. However, the percentage of CD34+ cell was increased in hypo-AML and in all 3 (100%) patients of hypo-MDS.…”

“…Although few studies have focused on immunohistochemical expression of CD117. 7,23 CD117 has been recently proposed as an additional marker to identify myeloid precursor cells in marrow biopsies of patients with MDS. In our study, the expressions of CD117 in all cases were also divided into 4 patterns.…”

“…24 As reported in the literature, anti-CD117 is a less reliable marker than CD34 due to its weak and variable expression in MDS myeloblasts. 7,25 In addition, CD34 is also expressed on endothelial cells, and CD117 is also expressed on mast cells in the bone marrow biopsy specimens. Therefore, combined detection of CD34 and CD117 in bone marrow biopsy samples could reduce the rate of false positives and enhance the diagnostic confidence of MDS.…”

“…Aplastic anemia (AA) is characterized by peripheral pancytopenia and significantly decreased cellularity in the bone marrow, 4,5 which overlaps with the clinical signs and symptoms and laboratory tests of hypocellular MDS. 6,7 Over the past several decades, there are increasing evidences that the histologic assessment of the bone marrow biopsy (BMB) is as important in myeloid neoplasms as it is in MDS, yielding essential diagnostic and prognostic information. In addition, BMB is considered to be more useful if the BM is hemodiluted or inaspirable, due to a large number of causes that may include marked reticulin fibrosis, technique of obtaining the BM specimens, and other causes.…”