Multiple Myeloma is a plasma cell neoplasm characterized by the Proliferation of monoclonal plasma cells in the bone marrow, associated with the synthesis of a monoclonal protein, either complete or incomplete (light chains only), These neoplastic plasma cells evolve from B Lymphocytes . Angiogenesis, or the formation of new blood vessels from pre-existing vessels during adult life, is an important natural process occurring in the body, both in health and in disease. Increase bone marrow angiogenesis has been demonstrated in a variety of solid tumors as well as hematologic disorders, including multiple myeloma. proliferative cell nuclear antigen (PCNA) is an indicater of the proliferative state of the cell . It is expresse in normal cells and in many malignant and non malignant diseases. PCNA is highly expressed in myeloma plasma cells reflecting a proliferative activity of these cells . Aim of the study: 1. Assessment of angiogenesis in multiple myeloma using CD34 marker. 2.Assessment of the proliferative activity of multiple myeloma using proliferating antigen (PCNA). 3.Investigate the relation of CD34 and PCNA with various clinicopathological parameters; as well as the correlation between the two markers. 4.To investigate the possibility of using CD34 and PCNA as an auxillary prognostic markers. Subjects, materials and methods. This retrospective study was conducted from may 2007 to Jaunary 2008 on 37 bone marrow biopsies diagnosed as multiple myeloma, along with 10 age matched control subjects who had reactive plasmacytosis in the bone marrow.
The cases were retrieved from recording archive files of Department of Pathology in the Teaching Laboratory of Medical City Hospital, laboratory of Al- Yarmouk hospital and AL-Yarmouk National Center of Haematology.Three sections were taken from each formalin fixed paraffin embedded bone marrow of MM and of control cases. One representative section was stained with Hematoxylin and Eosin (H&E), while the other two sections were stained immunohistochemically for CD34 and for PCNA. Clinicopathological parameters including age, sex, clinical presentation and laboratory investigation including PCV, WBC count, platelet count, blood urea, serum creatinine ,serum calcium, protein electrophoresis ,C-reactive protein were collected from the patients archive files. All stained sections were examined by light microscopy at X100, X200,X400 magnification and five areas of the highest neovascularization (hot spots) were examined .Then the mean vessel density (MVD) for CD34 and the labeling index ( percentage of positive nuclear staining) for PCNA was estimated . Result: This study revealed that there was a significant increase in the microvessel density in multiple myeloma cases compared to control subjects using antiCD34, also there was a significant increase in the expression of PCNA in plasma cells in patients with multiple myeloma compared to control cases. Moreover this study showed that there was a significant positive correlation between both CD34 and PCNA and the percent of plasma cell in the bone marrow of patient with multiple myeloma.There was a linear positive significant correlation between PCNA and CD34. Also there was an insignificant correlation between both PCNA and CD34 with blood urea , serum creatinine ,serum calcium age, platelet count, WBC count , however there was significant negative correlation between CD34 and PCV and not with PCNA. Conclusion: *This study showed that bone marrow angiogenesis using CD34 was significantly increased in multiple myeloma compared to control subjects. *This study showed the expression of PCNA in bone marrow of patients with multiple myeloma was significantly increase compared to control subject. *There was a significant positive correlation between PCNA and CD34, and a significant positive correlation between both CD34 and PCNA and the percentage of plasma cell in patient with multiple myeloma ,thus we may conclude that PCNA and CD34 are closely related markers which reflect high proliferative activity of multiple myeloma .