Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 3966
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size

LETTER TO EDITOR Table of Contents   
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

Click here for correspondence address and email

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 2022 Aug 13];52:599-600. Available from: https://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      

Correspondence Address:
S Gujral
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.56153

Rights and Permissions


  [Figure 1]

This article has been cited by
1 Emperipolesis: Sternal and Femoral Microenvironment Induces Megakaryiocyte Emperipolesis in the Wistar Strain
Damir Suljevic, Filip Filipic, Erna Islamagic
Macedonian Veterinary Review. 2019; 42(1): 71
[Pubmed] | [DOI]
2 A case of marginal zone lymphoma with extensive emperipolesis diagnosed on pleural effusion cytology with immunocytochemistry and flow cytometry
S. Meykler,Z. W. Baloch,J. E. Barroeta
Cytopathology. 2015; : n/a
[Pubmed] | [DOI]
3 Mass-forming primary angiitis of central nervous system with Rosai-Dorfmann disease-like massive histiocytosis with emperipolesis
Seong-Ik Kim,Soo Hee Kim,Hwa Jin Cho,Hannah Kim,Chun-Kee Chung,Seung Hong Choi,Sung-Hye Park
Pathology International. 2015; 65(8): 420
[Pubmed] | [DOI]
4 Morphological Changes in the Bone Marrow of the Dogs with Visceral Leishmaniasis
Claudia Momo,Ana Paula Prudente Jacintho,Pamela Rodrigues Reina Moreira,Danísio Prado Munari,Gisele Fabrino Machado,Rosemeri de Oliveira Vasconcelos
Veterinary Medicine International. 2014; 2014: 1
[Pubmed] | [DOI]
5 The effects of acrylamide on the frequency of megakaryocytic emperipolesis and the mitotic activity of rat bone marrow cells
Yeşim Yener, Musa Dikmenli
Journal of the Science of Food and Agriculture. 2011; : n/a
[VIEW] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures

 Article Access Statistics
    PDF Downloaded335    
    Comments [Add]    
    Cited by others 5    

Recommend this journal