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Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 599-600
Megakaryocytic emperipolesis: A histological finding in myelodysplastic syndrome


Hematopathology Laboratory, Department of Pathology, Tata Memorial Hospital, Mumbai, India

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Date of Web Publication1-Oct-2009
 

How to cite this article:
Sable M N, Sehgal K, Gadage V S, Subramanian P G, Gujral S. Megakaryocytic emperipolesis: A histological finding in myelodysplastic syndrome. Indian J Pathol Microbiol 2009;52:599-600

How to cite this URL:
Sable M N, Sehgal K, Gadage V S, Subramanian P G, Gujral S. Megakaryocytic emperipolesis: A histological finding in myelodysplastic syndrome. Indian J Pathol Microbiol [serial online] 2009 [cited 2017 Oct 23];52:599-600. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/599/56153


Emperipolesis, a biological phenomenon, was defined by Humble [1] et al. (1956) as, "the active penetration of one cell by another which remains intact". It differs from phagocytosis because the engulfed cell exists within another cell, remains viable, and can exit with no physiological and morphological consequence for either of them. [1] Etiopathogenesis of emperipolesis is uncertain. It is particularly seen in hematolymphoid disorders such as myeloproliferative disorders, nonHodgkin's lymphoma, idiopathic myelofibrosis, myelodysplastic syndrome (MDS), and few other nonhematological malignancies. [2]

We report a case of extensive megakaryocytic emperipolesis on histology in a patient with MDS. There have been only a few reports to date of megakaryocytic emperipolesis in MDS. [3],[4]

A 52-year-old male, known diabetic and hypertensive, presented with weakness and fatiguability of six weeks duration. On examination, he had pallor. There was no organomegaly. He had pancytopenia with hemoglobin of 8.1 g/dl, hematocrit 23.5%, reticulocyte count 4%, leukocyte count of 2.3Χ10 9 /L, and platelet count of 66.0Χ10 9 /L. Folic acid level was in normal range. Antinuclear antibody studies, Direct Coomb's test, and Paroxysmal Nocturnal Hemoglobinuria studies were negative. Serological screening studies for Human immunodeficiency virus (HIV), Hepatitis B and C viruses, were negative.

Bone marrow (BM) examination revealed a hypercellular marrow with trilineage hematopoiesis, showing megaloblastic erythroid hyperplasia. Megakaryocytes were adequate but showed dysmegakaryopoiesis in the form of monolobated and multinucleated megakaryocytes. Emperipolesis was a striking feature and was noted in almost all the megakaryocytes [Figure 1]. Mild myelofibrosis was seen. BM aspirate revealed 12% blasts along with dysmegakaryopoiesis and megakaryocytic emperipolesis. A diagnosis of MDS, Refractory anemia with excess of blasts-2 (RAEB-2) was rendered. Cytogenetic evaluation of this patient could not be done.

MDS represents a spectrum of stem cell malignancies which manifest as dysplastic and ineffective hematopoiesis. MDS is diagnosed as per the WHO criteria based on peripheral blood smear and BM aspirate cytology. Paraffin embedded BM trephine biopsy provides a means of assessing intact tissue for cellularity, architecture, morphology of hematopoietic elements and bony trabeculae; such as abnormal localization of immature precursors (ALIP), dyspoiesis, and fibrosis. Dysmegakaryopoiesis is commonly observed in MDS. Significance of emperipolesis in megakaryocytes is not clear as emperipolesis of neutrophils within megakaryocytes is also known in 5% of normal BM biopsies. [2] Few studies indicated that the release of alpha-granular proteins, growth factors and cytokines produced by megakaryocytes, as well as, neutrophils protease in the microenvironment induce emperipolesis. [2]

Presence of such extensive megakaryocytic emperipolesis has not been documented in the literature. Whether this is an incidental finding or one which bears significant correlation with MDS, is a fact that needs to be ascertained further. [5]

 
   References Top

1.Humble JG, Jaynee WHM, Pulvertaft RJ. Biological interaction between lymphocyte and other cells. Br J Hematol 1956;2:283.  Back to cited text no. 1      
2.Schmitt A, Jouault H, Guichard J. Pathological interaction between megakaryocytes and polymorphonuclear leukocyte in myelofibrosis. Blood 2000;96:1342-47.  Back to cited text no. 2      
3.Kawabata H, Sawaki T, Kawanami T. A case report, myelodysplastic syndrome complicated with inflammatory intestinal ulcers: Significance of Trisomy 8. Internal medicine 2006;45:1309-14.  Back to cited text no. 3      
4.Natori H, Natori K, Nakamura E.Emperipolesis in RAEB in T (RAEB in transformation). Rinsko Ketsueki 1998;29:1504-10.  Back to cited text no. 4      
5.Centurione L, Baldassarre A, Zingariello M . Increased and pathologic emperipolesis of neutrophils within megakaryocytes associated with marrow fibrosis in GATA-1 mice. Blood 2004;104:3573-80.  Back to cited text no. 5      

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Correspondence Address:
S Gujral
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.56153

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