Diagnostic challenges in the work up of hypereosinophilia: pitfalls in bone marrow core biopsy interpretation

Annals of Hematology
Juliana SchwaabGeorgia Metzgeroth

Abstract

The FIP1L1-PDGFRA (FP) fusion gene is identified in a substantial proportion of patients with eosinophilia-associated myeloproliferative neoplasms (MPN-eo) who subsequently achieve rapid and durable remissions on imatinib. In the initial diagnostic work-up of hypereosinophilia (HE), histologic and immunohistochemical evaluation of a bone marrow (BM) core biopsy is considered essential for the differentiation between reactive hypereosinophilia (HER), MPN-eo and hypereosinophilic syndrome (HES). We therefore retrospectively analysed the initial reports of BM core biopsies from 116 patients who were subsequently identified as FP positive (FP+, n = 56) or FP negative/corticosteroid-responsive HER or HES (n = 60). Compared to HER or HES, detection of FP was more frequently associated with increased numbers of blasts (11/56 vs. 2/60, p = 0.007) and mast cells (23/33 vs. 7/23, p = 0.006; with expression of CD25 [11/18 vs. 2/13, p = 0.025]), and/or fibrosis (25/35 vs. 1/23, p < 0.0001). In FP+ patients, HE was correctly associated with an underlying clonal haematologic disorder in only 36/56 (64 %) of cases, but final BM diagnoses included a variety of diagnoses such as MPN-eo (n = 15), acute myeloid leukaemia (n = 8), systemic mastocy...Continue Reading

References

Oct 28, 2008·British Journal of Haematology·Georgia MetzgerothAndreas Reiter
Nov 7, 2008·Leukemia·C WalzUNKNOWN European LeukemiaNet
Jan 4, 2013·The World Allergy Organization Journal·Peter ValentGerald J Gleich
Aug 30, 2014·Expert Review of Hematology·Peter ValentMichel Arock

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Citations

Dec 29, 2016·Blood·Andreas Reiter, Jason Gotlib
Nov 18, 2017·Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA·R E MäkitieO Mäkitie
May 20, 2020·Indian Journal of Hematology & Blood Transfusion : an Official Journal of Indian Society of Hematology and Blood Transfusion·Sreejesh SreedharanunniNeelam Varma
Jan 10, 2021·International Journal of Molecular Sciences·Stefania StellaPaolo Vigneri

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