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This study aimed to quantify Ki-67 expression across hematopoietic lineages in bone marrow biopsies (BMB) from MDS patients and assess its correlation with clinical features and outcomes. We performed single and double immunohistochemistry for Ki-67 with CD34, CD71, MPO, and Factor VIII on BMB samples from 73 patients diagnosed with MDS or oligoblastic acute myeloid leukemia (AML) at a single center. The cohort had a median age of 70 years, 56% were male, 81% had de novo MDS, and 15% therapy-related MDS. Abnormal karyotypes were present in 32%, and 52% had International Prognostic Scoring System scores\u2009\u2265\u20093.5. Median overall survival (OS) and progression-free survival (PFS) were 2.8 and 2.7 years, respectively. Ki-67 expression upper 10% occurred in 27% of patients. Coexpression of Ki-67 with CD34, MPO, CD71, and Factor VIII was observed in 79%, 63%, 85%, and 16% of cases, respectively. Notably, coexpression Ki-67 with Factor VIII+ correlated with higher blast counts, shorter PFS (HR 3.29), and reduced OS (HR 2.96). Incorporating Ki-67\/Factor VIII double labeling improved prognostic accuracy when added to the IPSS-R model. Ki-67 expression in megakaryocytes is a potential independent prognostic marker that requires validation in larger prospective cohorts and may reflect a bone marrow microenvironment dysregulation.<\/jats:p>","DOI":"10.1007\/s00428-026-04656-2","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:14:23Z","timestamp":1785921263000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ki-67 Expression in megakaryocytes: A new prognostic marker in Myelodysplastic Syndromes"],"prefix":"10.1007","author":[{"given":"Ligia Poletto","family":"Vara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiane R\u00fabia","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thales Dalessandro Meneguin","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Buccheri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Jun","family":"Otuyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim Gasparini","family":"dos Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanderson","family":"Rocha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira Deolinda Rodrigues Pereira","family":"Velloso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"4656_CR1","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1056\/NEJMra1904794","volume":"383","author":"M Cazzola","year":"2020","unstructured":"Cazzola M (2020) Myelodysplastic syndromes. 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