Bone marrow biopsy in children: A study of 111 patients

Abstract

Closed trephine needle biopsy of the bone marrow has become an established procedure in the evaluation of many malignant and benign diseases in adults; however, its role in pediatric pathology has not yet been defined. In the period from February 1974 to April 1978 we have performed 164 such biopsies in 111 children under 15 years of age. A representative specimen has been obtained in over 80% of cases. This series included, in order of frequency, non-Hodgkin lymphomas, Hodgkin lymphomas, aplastic anemias, rhabdomyosarcomas, neuroblastomas, miscellaneous solid tumors, and single cases of histiocytosis X, malignant histiocytosis, sarcoidosis, malignant histiocytoma, and Castleman lymphoma of the hyaline-vascular type. Histology has been found superior to cytology in the detection of neuroblastoma invasion; the evaluation of the true cellularity in aplastic anemia, and the detection of granulomatous tissue in the only case of sarcoidosis. In other diseases histology and cytology gave similar information, except for the few cases of acute leukemia in partial relapse, which has been better defined in the aspirate smears than in the core specimen. Further evaluation of this technique in other patient series appears advisable.

Bone Marrow Involvement in Neuroblastoma: A Study of Hemato-morphological Features

“…A similar incidence was found by Cozzutto et al [13] who reported it in 58.3 % cases (in 7 out of 12 cases) and Franklin et al [14] who reported it in 48.9 % cases (in 24 out of 49 cases). In a recent study which evaluated the incidence of bone marrow involvement at presentation in pediatric non-hematological small round cell tumours in children, found that neuroblastoma was the most common non-hematopoietic tumor to metastasize to bone marrow seen in 48.8 % cases followed by retinoblastoma (11.1 %), Ewing's sarcoma/PNET (8.6 %) and rhabdomyosarcoma (3.2 %) [15].…”

Clinicopathological Study of Diseases Homing and Infiltrating Bone Marrow in Children Less Than 3 Years of Age

“…While another series reported lymphomas as the commonest condition infiltrating the bone marrow [13] .…”

Myelofibrosis in neuroblastoma

“…Fibrosis was found in eight cases with extensive involvement and marrow necrosis was present in eight cases. In another study comparing bone marrow aspiration with biopsy in the diagnosis of metastatic childhood tumors [4], bone marrow aspirates in three of twelve patients with neuroblastoma demonstrated the presence of tumor cells, whereas in seven of the twelve, tumor cells were identified in biopsy specimens. In this series, tumor cell involvement was characterized by the presence of nodular or cord-like collections of pleomorphic tumor cells associated with a discrete stromal reaction; the bone marrow of these patients contained abundant fibrillar connective tissue with a relative absence of normal hematopoietic cells.…”

“…Myelofibrosis is rarely seen in children; the majority of reported cases of myelofibrosis in children were associated with acute leukemia [11][12] or were idiopathic in origin [ 10-121. Bone marrow examination is a usual part of the evaluation of patients with metastatic neuroblastoma [20-211. Bone marrow biopsy in such patients has also been recommended [4,20] but is not always performed. In a reported study of a group of patients with neuroblastoma, 40 bone marrow biopsies were performed in 31 patients [5].…”

“…In contrast, myelofibrosis in children in response to malignancy is rare and in general has been reported only as a complication of hematopoietic malignancies (ie, leukemia or lymphoma [lo-121) and bone diseases [13-141. It is not generally recognized that myelofibrosis may also occur in neuroblastoma [4,5]. In this report, we describe a child who presented with myelofibrosis, and in whom a diagnosis of neuroblastoma was subsequently established.…”