Clinicopathological features of bone marrow infiltration in hodgkin lymphoma. should bone marrow staging be done only in high risk patients?

Abstract

Objective: the frequency of bone marrow infiltration by Hodgkin lymphoma is low and varies from 3 to 18%. Hence there exists a dilemma whether bone marrow staging should be done only in the high risk cases. this study aims to study the clinicopathological features and the histomorphology of bone marrow infiltration by Hodgkin lymphoma. Material and Method:Bone marrow aspirates and biopsies from cases of Hodgkin lymphoma diagnosed between 2007 and 2015 were studied. immunohistochemistry with CD15 and CD30 were done in necessary cases. Bone marrow infiltration was correlated with various clinicopathological parameters.Results: ten of the 81 cases (12.3%) studied showed infiltration by Hodgkin lymphoma in the bone marrow biopsy sections. all the aspirates were negative. Bone marrow in the involved cases showed Reed-Sternberg cells and/or mononuclear Hodgkin cells positive for CD30 in a polymorphous inflammatory background. Cases of lymphocyte depleted subtype (66%) and those with leucopenia/ thrombocytopenia (100%) were frequently associated with bone marrow infiltration. B-symptoms, anemia and mixed cellularity were the other risk factors. However none of these risk factors were noted in two out of the ten cases with bone marrow infiltration.Conclusion: as the role of bone marrow aspirate is minimal in the staging of Hodgkin lymphoma, bone marrow biopsy should be the method of choice. immunohistochemistry helps in the doubtful cases. Bone marrow involvement was frequent but not confined to the high risk groups. Our findings suggest that bone marrow staging should not be restricted to the high risk cases alone.

Performance of Positron Emission Tomography-Computed Tomography and Bone Marrow Biopsy in Detecting Bone Marrow Infiltration in Lymphoma Cases

“…BMB, which plays an important role in lymphoma staging, is an invasive method based on the examination of a very small area. BMI ascertained by BMB is detected in approximately 3-18% of HL cases [15], while it is observed in NHL between 29% and 69% [16]. In our study, while BMI ascertained by BMB was found to be 24.5% in NHL patients, this rate was 11.8% in HL patients.…”

High Prevalence of Bone Marrow Involvement and Advanced Disease in Saudi Patients Diagnosed With Hodgkin Lymphoma

“…Interestingly, 80 (57.14%) patients were males, and it is predominantly noted that HL is frequently reported in male patients. A higher male-to-female ratio has also been reported in other studies [ 5 , 8 ].…”

Clinically Undetected Hodgkin Lymphoma Diagnosed Initially on Bone Marrow Biopsy: A Large Retrospective Observational Study from a Tertiary Care Center

“…Many studies revealed that the presence of "B" symptoms and cytopenias, especially leucopenia and thrombocytopenia, were frequently associated with BM involvement by HL. [17][18][19][20] BM aspirates are comparatively of lesser diagnostic value in diagnosing HL, as the involved marrow is difficult to aspirate due to marrow fibrosis. 2,21 As the aspirates were aparticulate or hypocellular, there is no/limited role of flow cytometry in the diagnosis of HL involving marrow.…”

“…5 Diffuse involvement of BM was seen in 66.7% of our cases and focal nodular aggregates were seen in 33.3% of cases, similar to other studies. 17 Diagnosis of marrow involvement by HL is challenging, especially when there is no prior diagnosis on a lymph node or other site in the body. Knowledge of histomorphology in correlation with clinicopathological features is essential to diagnose HL on the marrow.…”