Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(01): 069-077
DOI: 10.1055/s-0042-1751318
Original Article

Challenges Encountered and Pattern-Based Analysis of Bone Marrow Biopsy in Lymphomas: An Institutional Experience

Supreet Kaur Kalra
1   Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Sankalp Sancheti
1   Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Puneet Kaur Somal
1   Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Akash Pramod Sali
1   Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Aishwarya Sharma
1   Department of Pathology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Alok Goel
2   Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Shivani Jain
2   Department of Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Tapas Kumar Dora
3   Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Ashish Gulia
4   Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
,
Jigeeshu V. Divetia
4   Department of Surgical Oncology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
5   Department of Anaesthesiology, Homi Bhabha Cancer Hospital and Research Centre (a unit of Tata Memorial Centre), Sangrur, Punjab, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The evaluation of bone marrow (BM) status is an integral part of the initial workup of patients diagnosed with lymphoma as it plays an important role in staging and predicting prognosis in these patients. This article determines the incidence and pattern of BM involvement in lymphoma cases and distinguishes benign from malignant lymphoid aggregates in BM biopsies.

Materials and Methods The study group included 121 cases of Hodgkin and non-Hodgkin lymphomas for which BM biopsies were performed, fixed in acetic acid-zinc formalin solution, decalcified using 10% formic acid, and subjected to hematoxylin and eosin and immunohistochemistry.

Results The overall incidence of BM biopsy involvement in our study was 31.4% (37/118), including 34.7% (35/101) in cases of B cell lymphomas, 25% (2/8) in cases of T cell lymphomas, and no involvement in Hodgkin lymphoma. The predominant histological pattern of BM involvement was diffused (14/37; 37.8%), followed by interstitial (10/37; 27.1%). Five cases revealed benign nonparatrabecular lymphoid aggregates which could be confused with lymphomatous involvement, especially in low grade lymphomas.

Conclusion A careful examination of the BM biopsies along with clinical history, peripheral blood examination, flow cytometry, and immunohistochemistry will help in arriving at the correct diagnosis.

Keywords

marrow - lymphomas - Hodgkin lymphoma - non-Hodgkin lymphoma


Publication History

Article published online:
17 August 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Park Y, Park BB, Jeong JY. et al. Assessment of bone marrow involvement in patients with lymphoma: report on a consensus meeting of the Korean Society of Hematology Lymphoma Working Party. Korean J Intern Med (Korean Assoc Intern Med) 2016; 31 (06) 1030-1041
    PubMedGoogle Scholar
  • 2 Zhang QY, Foucar K. Bone marrow involvement by Hodgkin and non-Hodgkin lymphomas. Hematol Oncol Clin North Am 2009; 23 (04) 873-902
    CrossrefPubMedGoogle Scholar
  • 3 Subramanian R, Basu D, Badhe B, Dutta TK. Role of bone marrow trephine biopsy in the diagnosis of marrow involvement in Hodgkin's disease. Indian J Pathol Microbiol 2007; 50 (03) 640-643
    PubMedGoogle Scholar
  • 4 Caldarella C, Isgrò MA, Treglia G. Bone marrow involvement in Hodgkin and non-Hodgkin lymphomas: the role of fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography. J Bone Marrow Res 2014; 2 (01) 111
    CrossrefGoogle Scholar
  • 5 Lambertenghi-Deliliers G, Annaloro C, Soligo D. et al. Incidence and histological features of bone marrow involvement in malignant lymphomas. Ann Hematol 1992; 65 (02) 61-65
    CrossrefPubMedGoogle Scholar
  • 6 Kang YH, Park CJ, Seo EJ. et al. Polymerase chain reaction-based diagnosis of bone marrow involvement in 170 cases of non-Hodgkin lymphoma. Cancer 2002; 94 (12) 3073-3082
    CrossrefPubMedGoogle Scholar
  • 7 Viswanatha D, Foucar K. Hodgkin and non-Hodgkin lymphoma involving bone marrow. Semin Diagn Pathol 2003; 20 (03) 196-210
    CrossrefPubMedGoogle Scholar
  • 8 Arber DA, George TI. Bone marrow biopsy involvement by non-Hodgkin's lymphoma: frequency of lymphoma types, patterns, blood involvement, and discordance with other sites in 450 specimens. Am J Surg Pathol 2005; 29 (12) 1549-1557
    CrossrefPubMedGoogle Scholar
  • 9 Canioni D, Brice P, Lepage E. et al; Groupe d'Etude des Lymphomes Folliculaires. Bone marrow histological patterns can predict survival of patients with grade 1 or 2 follicular lymphoma: a study from the Groupe d'Etude des Lymphomes Folliculaires. Br J Haematol 2004; 126 (03) 364-371
    CrossrefPubMedGoogle Scholar
  • 10 Schmidt B, Kremer M, Götze K. et al. Bone marrow involvement in follicular lymphoma: comparison of histology and flow cytometry as staging procedures. Leuk Lymphoma 2006; 47 (09) 1857-1862
    CrossrefPubMedGoogle Scholar
  • 11 Abramson JS. T-cell/histiocyte-rich B-cell lymphoma: biology, diagnosis, and management. Oncologist 2006; 11 (04) 384-392
    CrossrefPubMedGoogle Scholar
  • 12 Chung R, Lai R, Wei P. et al. Concordant but not discordant bone marrow involvement in diffuse large B-cell lymphoma predicts a poor clinical outcome independent of the International Prognostic Index. Blood 2007; 110 (04) 1278-1282
    CrossrefPubMedGoogle Scholar
  • 13 Talaulikar D, Dahlstrom JE, Shadbolt B, Broomfield A, McDonald A. Role of immunohistochemistry in staging diffuse large B-cell lymphoma (DLBCL). J Histochem Cytochem 2008; 56 (10) 893-900
    CrossrefPubMedGoogle Scholar
  • 14 Vassilakopoulos TP, Angelopoulou MK, Constantinou N. et al. Development and validation of a clinical prediction rule for bone marrow involvement in patients with Hodgkin lymphoma. Blood 2005; 105 (05) 1875-1880
    CrossrefPubMedGoogle Scholar
  • 15 Foucar K, Viswanatha DS, Wilson CS. Non-neoplastic lymphoid and plasma cell disorders. In: King DW. ed. Non-Neoplastic Disorders of Bone Marrow. Washington, DC: American Registry of Pathology; 2008: 249-282 . AFIP Atlas of Nontumor Pathology; 1st series
    Google Scholar
  • 16 Thiele J, Zirbes TK, Kvasnicka HM, Fischer R. Focal lymphoid aggregates (nodules) in bone marrow biopsies: differentiation between benign hyperplasia and malignant lymphoma–a practical guideline. J Clin Pathol 1999; 52 (04) 294-300
    CrossrefPubMedGoogle Scholar
  • 17 Salisbury JR, Deverell MH, Cookson MJ. Three-dimensional reconstruction of benign lymphoid aggregates in bone marrow trephines. J Pathol 1996; 178 (04) 447-450
    CrossrefPubMedGoogle Scholar
  • 18 Johnston A, Brynes RK, Naemi K. et al. Differentiating benign from malignant bone marrow B-cell lymphoid aggregates: a statistical analysis of distinguishing features. Arch Pathol Lab Med 2015; 139 (02) 233-240
    CrossrefPubMedGoogle Scholar
  • 19 Naemi K, Brynes RK, Reisian N. et al. Benign lymphoid aggregates in the bone marrow: distribution patterns of B and T lymphocytes. Hum Pathol 2013; 44 (04) 512-520
    CrossrefPubMedGoogle Scholar
  • 20 Brunning RD, Bloomfield CD, McKenna RW, Peterson LA. Bilateral trephine bone marrow biopsies in lymphoma and other neoplastic diseases. Ann Intern Med 1975; 82 (03) 365-366
    CrossrefPubMedGoogle Scholar
  • 21 Foucar K, McKenna RW, Frizzera G, Brunning RD. Bone marrow and blood involvement by lymphoma in relationship to the Lukes–Collins classification. Cancer 1982; 49 (05) 888-897
    CrossrefPubMedGoogle Scholar
  • 22 Varma N, Dash S, Sarode R, Marwaha N. Relative efficacy of bone marrow trephine biopsy sections as compared to trephine imprints and aspiration smears in routine hematological practice. Indian J Pathol Microbiol 1993; 36 (03) 215-226
    PubMedGoogle Scholar
  • 23 Schmid C, Isaacson PG. Bone marrow trephine biopsy in lymphoproliferative disease. J Clin Pathol 1992; 45 (09) 745-750
    CrossrefPubMedGoogle Scholar
  • 24 Kumar S, Rau AR, Naik R. et al. Bone marrow biopsy in non-Hodgkin lymphoma: a morphological study. Indian J Pathol Microbiol 2009; 52 (03) 332-338
    CrossrefPubMedGoogle Scholar
  • 25 Adelstein DJ, Henry MB, Bowman LS, Hines JD. Diffuse well differentiated lymphocytic lymphoma: a clinical study of 22 patients. Oncology 1991; 48 (01) 48-53
    CrossrefPubMedGoogle Scholar
  • 26 Geisler C, Ralfkiaer E, Hansen MM, Hou-Jensen K, Larsen SO. The bone marrow histological pattern has independent prognostic value in early stage chronic lymphocytic leukaemia. Br J Haematol 1986; 62 (01) 47-54
    CrossrefPubMedGoogle Scholar