Pseudo-Pelger-Fluet Anomaly Induced by Medications A Clinicopathologic Study in Comparison With Myelodysplastic Syndrome-Related Pseudo-Pelger-Huet Anomaly
Pseudo-Pelger-Fluet Anomaly Induced by Medications A Clinicopathologic Study in Comparison With Myelodysplastic Syndrome-Related Pseudo-Pelger-Huet Anomaly
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DOI：
10.1309/ajcpvfy95maobkrs
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发表时间：
2011-02-01
影响因子：
3.5
通讯作者：
Huang, Qin
中科院分区：
文献类型：
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作者：
Wang, Endi;Boswell, Elizabeth;Huang, Qin
伪 Pelger-Huet 异常 (PPHA) 已被记录与移植药物和其他药物有关。这种医源性中性粒细胞发育不良可通过停止或调整药物而逆转，但经常与骨髓增生异常综合征 (MD) 相混淆，因为传统观念认为 PPHA 是发育不良的标志物。我们研究了医源性 PPHA 的临床病理特征，并将其与 MDS 相关 PPHA 进行比较。研究的13例病例包括5例骨髓/干细胞移植、3例实体器官移植、1例自身免疫性疾病、3例慢性淋巴细胞白血病和1例乳腺癌。对 12 例进行了随访评估，所有病例均表现出中性粒细胞分段至少短暂正常化。所有9例MDS在骨髓活检中均表现出至少2种以下病理异常：细胞增多（8/9）、形态发育不良（8/9）、克隆细胞遗传学异常（7/9）和原始细胞增多（3/9），而这些异常在医源性PPHA中通常不存在。医源性 PPHA 的循环 PPHA 细胞比例高于 MDS（平均值 47.4%；SD，31.6% vs 平均值 12.3%；SD，9.8；P < .01）。提出了一种诊断算法，其中孤立的 PPHA 指示暂时性或良性 PPHA，除非另有证明。
Pseudo-Pelger-Huet-anomaly (PPHA) has been documented in association with transplant medications and other drugs. This iatrogenic neutrophilic dysplasia is reversible with cessation or adjustment of medications but is frequently confused with myelodysplastic syndrome (MD) based on the conventional concept that PPHA is a marker for dysplasia. We investigated the clinicopathologic features in iatrogenic PPHA and compared them with MDS-related PPHA. The 13 cases studied included 5 bone marrow/stem cell transplantations, 3 solid organ transplantations, 1 auto immune disease, 3 chronic lymphocytic leukemias, and 1 breast carcinoma. For 12 cases, there was follow-up evaluation, and all demonstrated at least transient normalization of neutrophilic segmentation. All 9 cases of MDS demonstrated at least 2 of the following pathologic abnormalities on bone marrow biopsy: hypercellularity (8/9), morphologic dysplasia (8/9), clonal cytogenetic abnormality (7/9), and increased blasts (3/9), whereas these abnormalities were typically absent in iatrogenic PPHA. Iatrogenic PPHA displayed a higher proportion of circulating PPHA cells than in MDS (mean, 47.4%; SD, 31.6% vs mean, 12.3%; SD, 9.8; P < .01). A diagnostic algorithm is proposed in which isolated PPHA is indicative of transient or benign PPHA unless proven otherwise.