4769 Introduction: Bone marrow biopsy is essential for the staging and monitoring of patients with non-Hodgkin's lymphoma (NHL). Based on a 1975 study, bilateral bone marrow biopsy is the standard practice in many institutions. Similar studies were conducted later, but with conflicting results, inadequate description and little statistical assessment of the value of conducting bilateral vs. unilateral bone marrow biopsies for the evaluation of patients with NHL. Objectives: To explore whether a unilateral bone marrow biopsy is comparable in yield to bilateral biopsies in staging of patients with NHL. Methods: We retrospectively reviewed electronic pathology reports for bone marrow biopsies done at our institution for staging NHL. We also collected data for age, gender, type of NHL, percentage of disease involvement, and size of biopsy. Patients were divided into those who had bilateral biopsies vs. unilateral biopsies. The bilateral group was further divided into bilaterally positive (matching), versus only one side (aspirate and/or biopsy) positive (non-matching). Results: Between 1995 and 2010, 256 patients were identified with the diagnosis of NHL, and found eligible for the study. 146 patients (57%) had low grade NHL and 83 patients (32.4%) had diffuse large B-cell NHL.107 patients had bilateral, and 149 had unilateral bone marrow biopsies. Overall positivity rate was 46.7% for bilateral (either side or both) and 41.4% unilateral (chi square, p = 0.884). For the low grade NHL group, the positivity rate was 56.2% for bilateral (either side or both) and 57.9% unilateral. For the Diffuse Large B-cell NHL group, the positivity rate was 26.7% for bilateral (either side or both) and 23.7% unilateral. Within the bilateral group, 97 patients had bilateral positive results (matching) and 10 had only one side positive (non-matching). Within the bilateral group (107 patients), the sensitivity of either side being positive, (i.e. left side vs. either, or right side vs. either) was 90% and the negative predictive value was 92%. Positivity rate of unilateral bone marrow biopsies size (≥2cm) was 10% more than that with size (<2cm) but this difference was not statistically significant (chi square, p = 0.319). We also detected a gender difference, with right to left side results agreement better in men (p =0.03). This may be due to the difference in mean biopsy size found in our study by gender and side. The mean size of right side biopsy in bilateral positive group was (1.74 cm) in males vs. (1.16 cm) in females (t-test, p = 0.025). Conclusion: The yield of unilateral bone marrow biopsy in the staging of NHL is comparable and not inferior to bilateral biopsies. The sensitivity and negative predictive values of unilateral biopsy are very high for the cases reviewed at our institution. Therefore, unilateral rather than bilateral bone marrow biopsy can be routinely offered for staging lymphoma, particularly in men. This would help improve patients' convenience and should reduce the cost and time of this procedure. Disclosures: No relevant conflicts of interest to declare.
Hypereosinophilic syndrome (HES) includes a spectrum of diseases with eosinophilia and tissue damage. Two idiopathic causes of HES are the myeloproliferative variant (M‐HES)and the lymphocytic variant (L‐HES). L‐HES is a rare entity. It is characterized by clonal population of phenotypically abnormal T‐ lymphocytes. Clinical manifestations vary but cutaneous involvement is common. In this case we report a patient diagnosed with L‐HES with no clinical symptoms on presentation.A 56 year old male was initially being evaluated for leukocytosis with a differential showing 33% eosinophilia. Physical exam was unremarkable. The patient had an extensive workup to rule out secondary causes. Bone marrow biopsy revealed cellular marrow with eosinophilia (10% of cellularity). No evidence of myeloproliferative disorders. JAK2 mutation was negative as well as FISH for bcl‐abr gene and PDGFRA gene. Flow cytometry revealed an unusual population of CD4+, CD2+, CD3‐, and CD8‐ T‐lymphocytes.HES is an extremely heterogeneous disorder. Diagnostic criteria includes persistent eosinophilia of 1.5 × 109 eosinophils/L of blood, lack of evidence for secondary causes and presumptive signs of organ involvement. The L‐HES is an uncommon variant. Patients usually present with dermatologic manifestations. GI symptoms and obstructive lung disease are also common. Endomyocardial fibrosis and myelofibrosis are rarely seen. Cytokine IL‐5 also plays a role in pathogenesis. The most prevalent T cell clone associated with LHES seems to be the CD3‐CD4+ clone. L‐HES has a much better prognosis than M‐HES but patients with the CD3‐CD4+ clone can progress to T cell lymphoma. Despite the relatively low mortality in patients with LHES, morbidity is significant. L‐HES is steroid responsive while M‐HES is not. It is crucial to differentiate between the variants because of the vastly different treatment regimens and thus disease course.
IntroductionEndometrial carcinoma is the most common invasive cancer of the female genital tract accounting for 6% of all invasive cancers in women. The prognosis and surgical staging depends on the histologic grade, depth of myometrial invasion and cervical involvement. Surgical staging consists of total abdominal hysterectomy, bilateral salpingo‐oophorectomy, peritoneal cytology, and pelvic lymphadenectomy. Intraoperative frozen section analysis followed by formalin fixed permanent section analysis is used for surgical staging. We compared the accuracy of frozen section staging with the accuracy of permanent section staging.MethodsA retrospective analysis was performed on 46 consecutive patients with endometrial carcinoma between February 2005 and June 2010 at St. John Hospital and Medical Center in Detroit, Michigan. Frozen section staging was performed on all the cases followed by permanent section staging using the AJCC 7th edition staging manual.ResultsComparison between frozen section and permanent section examination did not show a significant difference in the depth of myometrial invasion (p = 0.7). A greater difference was observed with respect to cervical involvement, but this finding was not statistically significant (p = 0.2).ConclusionAlthough sampling of the specimen at frozen section has its limitations, the stage rendered through intraoperative examination generally correlates well with the pathologic stage reported upon permanent section examination.
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