Quality control initiative on the evaluation of the dysmegakaryopoiesis in myeloid neoplasms: Difficulties in the assessment of dysplasia

•The presence of micromegakaryocytes correlates strongly with myeloid neoplasia.•Micromegakaryocytes can be identified reliably.•Multinucleated megakaryocytes are not specific for myeloid neoplasia.•Cytoplasmic dysplasia is not useful in recognising MDS.•‘Possibly dysplastic’ cells should be exclude...

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Published in:	Leukemia research Vol. 45; pp. 75 - 81
Main Authors:	Goasguen, Jean E., Bennett, John M., Bain, Barbara J., Brunning, Richard D., Vallespí, Maria-Teresa, Tomonaga, Masao, Zini, Gina, Renault, Alain
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01.06.2016 Elsevier
Subjects:	Cancer Cell Shape Cell Size Dysmegakaryocytopoiesis Dysmegakaryopoiesis Dysmyelopoiesis Dysplastic features Hematologic Neoplasms - pathology Hematology Hematology, Oncology and Palliative Medicine Human health and pathology Humans Life Sciences Megakaryocyte Progenitor Cells Megakaryocytes Megakaryocytes - pathology Myelodysplastic syndrome Myelodysplastic Syndromes - diagnosis Myeloproliferative Disorders - diagnosis Quality Control Tissues and Organs Dysplastic features Megakaryocytes Dysmegakaryopoiesis Dysmegakaryocytopoiesis Myelodysplastic syndrome Dysmyelopoiesis myelodysplastic syndrome
ISSN:	0145-2126, 1873-5835, 1873-5835, 0145-2126
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Abstract	•The presence of micromegakaryocytes correlates strongly with myeloid neoplasia.•Micromegakaryocytes can be identified reliably.•Multinucleated megakaryocytes are not specific for myeloid neoplasia.•Cytoplasmic dysplasia is not useful in recognising MDS.•‘Possibly dysplastic’ cells should be excluded from counts in suspected MDS. Evaluation of megakaryocyte morphology is difficult but can be essential for the diagnosis of myelodysplastic syndromes (MDS) and other myeloid neoplasms. We agreed upon descriptions and provided images of megakaryoblasts and of normal and dysplastic megakaryocytes, which were used as a basis for assessing the concordance of expert morphologists in their recognition. We showed a high rate of concordance for the recognition of micromegakaryocytes and confirmed their strong association with hematologic neoplasia, including MDS. Concordance was also found to be good for the recognition of multinucleated megakaryocytes, which showed a significant association with MDS. However cytoplasmic abnormalities were found not to be useful in MDS recognition. The occurrence of appreciable numbers of nonlobulated and hypolobulated megakaryocytes in individuals without a myeloid neoplasm was confirmed. We demonstrated that subjects without a myeloid neoplasm can have some megakaryocytes that are assessed as ‘dysplastic’ or ‘possibly dysplastic’ and that to avoid over diagnosis of dysplasia, ‘possibly dysplastic’ forms should be excluded from the count of dysplastic cells. Our results demonstrate that the nature as well as the presence of megakaryocyte dysplasia is important in the diagnosis of MDS; although evaluation of 30 megakaryocytes is strongly recommended, it may be possible to recognize diagnostically important dysplasia when fewer megakaryocytes are present but highly diagnostic forms are seen.
AbstractList	•The presence of micromegakaryocytes correlates strongly with myeloid neoplasia.•Micromegakaryocytes can be identified reliably.•Multinucleated megakaryocytes are not specific for myeloid neoplasia.•Cytoplasmic dysplasia is not useful in recognising MDS.•‘Possibly dysplastic’ cells should be excluded from counts in suspected MDS. Evaluation of megakaryocyte morphology is difficult but can be essential for the diagnosis of myelodysplastic syndromes (MDS) and other myeloid neoplasms. We agreed upon descriptions and provided images of megakaryoblasts and of normal and dysplastic megakaryocytes, which were used as a basis for assessing the concordance of expert morphologists in their recognition. We showed a high rate of concordance for the recognition of micromegakaryocytes and confirmed their strong association with hematologic neoplasia, including MDS. Concordance was also found to be good for the recognition of multinucleated megakaryocytes, which showed a significant association with MDS. However cytoplasmic abnormalities were found not to be useful in MDS recognition. The occurrence of appreciable numbers of nonlobulated and hypolobulated megakaryocytes in individuals without a myeloid neoplasm was confirmed. We demonstrated that subjects without a myeloid neoplasm can have some megakaryocytes that are assessed as ‘dysplastic’ or ‘possibly dysplastic’ and that to avoid over diagnosis of dysplasia, ‘possibly dysplastic’ forms should be excluded from the count of dysplastic cells. Our results demonstrate that the nature as well as the presence of megakaryocyte dysplasia is important in the diagnosis of MDS; although evaluation of 30 megakaryocytes is strongly recommended, it may be possible to recognize diagnostically important dysplasia when fewer megakaryocytes are present but highly diagnostic forms are seen. Evaluation of megakaryocyte morphology is difficult but can be essential for the diagnosis of myelodysplastic syndromes (MDS) and other myeloid neoplasms. We agreed upon descriptions and provided images of megakaryoblasts and of normal and dysplastic megakaryocytes, which were used as a basis for assessing the concordance of expert morphologists in their recognition. We showed a high rate of concordance for the recognition of micromegakaryocytes and confirmed their strong association with hematologic neoplasia, including MDS. Concordance was also found to be good for the recognition of multinucleated megakaryocytes, which showed a significant association with MDS. However cytoplasmic abnormalities were found not to be useful in MDS recognition. The occurrence of appreciable numbers of nonlobulated and hypolobulated megakaryocytes in individuals without a myeloid neoplasm was confirmed. We demonstrated that subjects without a myeloid neoplasm can have some megakaryocytes that are assessed as 'dysplastic' or 'possibly dysplastic' and that to avoid over diagnosis of dysplasia, 'possibly dysplastic' forms should be excluded from the count of dysplastic cells. Our results demonstrate that the nature as well as the presence of megakaryocyte dysplasia is important in the diagnosis of MDS; although evaluation of 30 megakaryocytes is strongly recommended, it may be possible to recognize diagnostically important dysplasia when fewer megakaryocytes are present but highly diagnostic forms are seen. Highlights • The presence of micromegakaryocytes correlates strongly with myeloid neoplasia. • Micromegakaryocytes can be identified reliably. • Multinucleated megakaryocytes are not specific for myeloid neoplasia. • Cytoplasmic dysplasia is not useful in recognising MDS. • ‘Possibly dysplastic’ cells should be excluded from counts in suspected MDS. Evaluation of megakaryocyte morphology is difficult but can be essential for the diagnosis of myelodysplastic syndromes (MDS) and other myeloid neoplasms. We agreed upon descriptions and provided images of megakaryoblasts and of normal and dysplastic megakaryocytes, which were used as a basis for assessing the concordance of expert morphologists in their recognition. We showed a high rate of concordance for the recognition of micromegakaryocytes and confirmed their strong association with hematologic neoplasia, including MDS. Concordance was also found to be good for the recognition of multinucleated megakaryocytes, which showed a significant association with MDS. However cytoplasmic abnormalities were found not to be useful in MDS recognition. The occurrence of appreciable numbers of nonlobulated and hypolobulated megakaryocytes in individuals without a myeloid neoplasm was confirmed. We demonstrated that subjects without a myeloid neoplasm can have some megakaryocytes that are assessed as 'dysplastic' or 'possibly dysplastic' and that to avoid over diagnosis of dysplasia, 'possibly dysplastic' forms should be excluded from the count of dysplastic cells. Our results demonstrate that the nature as well as the presence of megakaryocyte dysplasia is important in the diagnosis of MDS; although evaluation of 30 megakaryocytes is strongly recommended, it may be possible to recognize diagnostically important dysplasia when fewer megakaryocytes are present but highly diagnostic forms are seen.Evaluation of megakaryocyte morphology is difficult but can be essential for the diagnosis of myelodysplastic syndromes (MDS) and other myeloid neoplasms. We agreed upon descriptions and provided images of megakaryoblasts and of normal and dysplastic megakaryocytes, which were used as a basis for assessing the concordance of expert morphologists in their recognition. We showed a high rate of concordance for the recognition of micromegakaryocytes and confirmed their strong association with hematologic neoplasia, including MDS. Concordance was also found to be good for the recognition of multinucleated megakaryocytes, which showed a significant association with MDS. However cytoplasmic abnormalities were found not to be useful in MDS recognition. The occurrence of appreciable numbers of nonlobulated and hypolobulated megakaryocytes in individuals without a myeloid neoplasm was confirmed. We demonstrated that subjects without a myeloid neoplasm can have some megakaryocytes that are assessed as 'dysplastic' or 'possibly dysplastic' and that to avoid over diagnosis of dysplasia, 'possibly dysplastic' forms should be excluded from the count of dysplastic cells. Our results demonstrate that the nature as well as the presence of megakaryocyte dysplasia is important in the diagnosis of MDS; although evaluation of 30 megakaryocytes is strongly recommended, it may be possible to recognize diagnostically important dysplasia when fewer megakaryocytes are present but highly diagnostic forms are seen.
Author	Brunning, Richard D. Renault, Alain Goasguen, Jean E. Vallespí, Maria-Teresa Tomonaga, Masao Bain, Barbara J. Bennett, John M. Zini, Gina
Author_xml	– sequence: 1 givenname: Jean E. surname: Goasguen fullname: Goasguen, Jean E. email: Jean.goasguen@orange.fr organization: University of Rennes, France – sequence: 2 givenname: John M. surname: Bennett fullname: Bennett, John M. organization: University of Rochester, NY, USA – sequence: 3 givenname: Barbara J. surname: Bain fullname: Bain, Barbara J. organization: Imperial College, London, UK – sequence: 4 givenname: Richard D. surname: Brunning fullname: Brunning, Richard D. organization: University of Minnesota, USA – sequence: 5 givenname: Maria-Teresa surname: Vallespí fullname: Vallespí, Maria-Teresa organization: Vall d’Hebrón Hospital, Barcelona, Spain – sequence: 6 givenname: Masao surname: Tomonaga fullname: Tomonaga, Masao organization: University of Nagasaki, Japan – sequence: 7 givenname: Gina surname: Zini fullname: Zini, Gina organization: Haematology Institute, Catholic University of Sacred Heart, Rome, Italy – sequence: 8 givenname: Alain surname: Renault fullname: Renault, Alain organization: University of Rennes and INSERM CIC1414, France
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Cites_doi	10.1111/j.1365-2141.1986.tb07550.x 10.1046/j.1365-2141.2000.01940.x 10.1038/leu.2014.161 10.1182/blood.V43.6.811.811 10.7326/0003-4819-103-3-460 10.1046/j.1365-2141.1996.d01-1786.x 10.1084/jem.36.1.1 10.1182/asheducation-2015.1.294 10.1159/000206652 10.1111/j.1365-2141.1982.tb08475.x 10.1080/1042819021000040279 10.1038/sj.leu.2404571 10.3816/CLK.2008.n.012
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Keywords	Dysplastic features Megakaryocytes Dysmegakaryopoiesis Dysmegakaryocytopoiesis Myelodysplastic syndrome Dysmyelopoiesis myelodysplastic syndrome
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Snippet	•The presence of micromegakaryocytes correlates strongly with myeloid neoplasia.•Micromegakaryocytes can be identified reliably.•Multinucleated megakaryocytes... Highlights • The presence of micromegakaryocytes correlates strongly with myeloid neoplasia. • Micromegakaryocytes can be identified reliably. • Multinucleated... Evaluation of megakaryocyte morphology is difficult but can be essential for the diagnosis of myelodysplastic syndromes (MDS) and other myeloid neoplasms. We...
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SubjectTerms	Cancer Cell Shape Cell Size Dysmegakaryocytopoiesis Dysmegakaryopoiesis Dysmyelopoiesis Dysplastic features Hematologic Neoplasms - pathology Hematology Hematology, Oncology and Palliative Medicine Human health and pathology Humans Life Sciences Megakaryocyte Progenitor Cells Megakaryocytes Megakaryocytes - pathology Myelodysplastic syndrome Myelodysplastic Syndromes - diagnosis Myeloproliferative Disorders - diagnosis Quality Control Tissues and Organs
Title	Quality control initiative on the evaluation of the dysmegakaryopoiesis in myeloid neoplasms: Difficulties in the assessment of dysplasia
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