Clinical and pathological feature of bone marrow granulomas: A modern Australian series

Crispin, Philip; Holmes, Andrew S.

doi:10.1111/ijlh.12751

Cited by 9 publications

(10 citation statements)

References 10 publications

(10 reference statements)

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“…However, in half of these 10 patients the BMB finding was granulomatous involvement. This feature in itself is not diagnostic, as granulomata are non‐specific and may be observed in the bone marrow in several conditions, including infection, malignancy and autoimmune diseases, which are all differential diagnoses in a patient with FUO . Furthermore, the morphological appearance of the granulomata also do not guide further investigation, which is dependent on other clinical features and laboratory and imaging investigations …”

Section: Discussionmentioning

confidence: 99%

“…10 Furthermore, the morphological appearance of the granulomata also do not guide further investigation, which is dependent on other clinical features and laboratory and imaging investigations. 10 BMB has been shown to be useful in the diagnosis of malignancy and infection. 2,3 In our cohort, BMB conferred a diagnosis of malignancy in five patients, however, the diagnoses in all these cases could have been made by biopsy of lesions seen on CT or FDG-PET.…”

Section: Discussionmentioning

confidence: 99%

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Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Hong

Fox

Chai

et al. 2019

Internal Medicine Journal

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Background Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies, such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18‐fluoro‐2‐deoxyglucose positron emission tomography (FDG‐PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. Aim To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. Methods Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known human immunodeficiency virus infection and previously diagnosed connective tissue diseases were excluded. Results Seventy‐three patients were included in the study. Fifty‐one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B‐cell lymphoma had normal BMB. FDG‐PET was helpful in making a diagnosis in eight (25%) out of 32 patients. Conclusion Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations, such as FDG‐PET, may be more likely to help establish a definitive diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Hong

Fox

Chai

et al. 2019

Internal Medicine Journal

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“…However, the relationship between granulomas and infectious diseases seems clear. Some case series place non-Hodgkin’s lymphomas as one of the most frequent causes for the development of granulomas, with no association with LPL [ 36 , 37 ]. The fact that granulomatous lesions were not found by the diagnostic BM biopsy (with massive LPL infiltration) in contrast with its finding on the sample with only 15% infiltration suggests that the most likely etiology was systemic infection caused by Candida tropicalis.…”

Section: Discussionmentioning

confidence: 99%

Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient

et al. 2023

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Waldenström macroglobulinemia (WM) is a slowly progressive hematologic malignancy that usually responds rapidly to treatment. Being a lymphoplasmacytoid neoplasm, it is associated with a monoclonal IgM component, which may be associated with multiple manifestations and symptoms. We report the case of a 77-year-old woman diagnosed with WM following the development of severe and sudden pancytopenia associated with a cold agglutinin syndrome. In order to treat the WM and the underlying hemolysis, treatment with rituximab, corticosteroids and cyclophosphamide was started. Despite the improvement in hemolysis parameters, pancytopenia persisted, and we started a second line with ibrutinib. During treatment the patient developed an uncommon invasive fungal infection (IFI) with bone marrow granulomatosis and myelofibrosis. This case shows an unusual clinical course with a poor hematopoietic response to treatment and a large number of intercurrent complications.

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“…Though the outcomes of our studies were in accordance with some previous Indian and Western literature, it must be noted that in countries such as Australia, where tuberculosis (TB) is a rare entity, causes of marrow granulomas are expected to be significantly different, as was evident from a recent publication where B cell non-Hodgkin lymphoma, sarcoidosis and autoimmune diseases were more common. 7,9…”

Section: Discussionmentioning

confidence: 99%

“…different, as was evident from a recent publication where B cell non-Hodgkin lymphoma, sarcoidosis and autoimmune diseases were more common. 7,9 In contrast to the above, Wang et al reported the highest incidence of infective aetiologies of BMGs (80/ 110 cases [72.8%]) from China. 10 TB was the most common cause (n ¼ 62), followed by fungi (n ¼ 4), typhoid or paratyphoid fever (n ¼ 3), and brucellosis (n ¼ 2).…”

Section: Diagnostic Patterns Remarksmentioning

confidence: 97%

Diagnostic utility of bone marrow examination in evaluation of fever: a descriptive study on 98 immunocompetent adults from a tertiary care institute in south India

et al. 2019

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Five-year clinico-laboratory data from 99 (one HIV seropositive) adults (mean age ¼ 41.3 AE 20.4 years) who underwent bone marrow examination for fever persisting for ! 1 week were analysed and correlated with microbiological characteristics. Infections, reactive marrow changes and haematolymphoid malignancies were most commonly associated with fever. A high concordance rate of 71% was noted between aspiration and trephine biopsies. Bone marrow granulomas (BMG) were seen exclusively on sections and were most commonly of tubercular and typhoidal in origin (two Salmonella Typhi, one Salmonella Paratyphi A). The common aetiologies associated with fever and cytopenia(s) were BMG, acute leukaemia and haemophagocytic lymphohistiocytosis (HLH; n ¼ 3). The yield from bone marrow culture was inferior compared to other body fluids. In conclusion, bone marrow histology is superior to smears in the evaluation of prolonged fever. Marrow culture may not be useful in immunocompetent individuals other than if Salmonellosis is suspected.

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Clinical and pathological feature of bone marrow granulomas: A modern Australian series

Abstract: Marrow granulomas are seen in a variety conditions. Neither their presence nor their morphological features are a guide to further investigations, which should be determined by the clinical presentation as appropriate.

Cited by 9 publications

References 10 publications

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context

Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient

Diagnostic utility of bone marrow examination in evaluation of fever: a descriptive study on 98 immunocompetent adults from a tertiary care institute in south India

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