Incidence and histological features of bone marrow involvement in malignant lymphomas

Abstract

Bone marrow biopsy (BMB) is a routine investigation in the diagnosis and staging of Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL), and there is evidence supporting its prognostic importance in some histological varieties. The histological characteristics of BMB in 433 NHL and 155 HD patients were reviewed for clinicopathological correlations; 36 of these cases were also studied by means of immunohistochemistry. BM infiltrates were discovered in 171 NHL patients. In 36 cases, the diagnosis of NHL was directly established by BMB; a discordance between lymph node and BM histology was observed in 38 of the other 135 cases. BM-positive centroblastic and immunoblastic NHL were significantly associated with larger infiltrates, BM fibrosis, and megakaryocytic hyperplasia. Leukemization at diagnosis was more frequent in low-malignancy NHL. No correlation was found between histology and prognosis, although immunohistochemistry revealed a B-cell phenotype in all but two cases. BMB was positive in 18 of the 155 HD patients and directly diagnostic in two; Reed-Sternberg and Hodgkin cells were CD-30 positive and surrounded by T-cell infiltration. The concordance between BM and lymph node histology was fairly satisfactory, although the relationships between BM infiltration and other histological parameters may reflect peculiar interactions with BM microenvironmental factors. The usefulness of BMB in the diagnosis of malignant lymphomas has been demonstrated, and further progress can be expected from the availability of reliable immunohistochemical markers of clonality reacting on paraffin-embedded BM sections.

Role of staging bone marrow examination in children with Hodgkin disease

“…In contrast, a survey of the literature revealed the average incidence of bone marrow involvement in adult patients to be 13-14%, with a range of 2-32% [6]. Characteristics associated with an increased incidence of bone marrow involvement from these series include male gender, older age, cytopenias, and either mixed cellularity or lymphocyte depletion [6][7][8][9]11,12]. Advanced stage disease and the presence of B-symptoms have also been associated with an increased incidence of marrow invasion ranging from 25-45% [6,7,12].…”

Bone Involvement in Hodgkin’s Lymphoma: Clinical Features and Outcome

“…PET/CT scanning has emerged as an important tool in the staging of patients with HL, and this adds significantly to the staging information obtained using other standard radiographic methods [4,5]. In the diagnosis and management of HL, 18F-fluorodeoxyglucose PET/CT is a functional imaging modality that has become a standard tool complementing contrastenhanced CT scans [9][10][11][12]. Several studies have shown that PET/CT helps to make a more accurate identification of the correct pretreatment stage in HL compared with contrast-enhanced CT, although PET/CT upstages disease from an early to an advanced stage in only 10-15% of patients whose treatment ultimately undergoes modification [4,5].…”

“…HL involving osseous sites must also be distinguished from the involvement of the bone marrow by HL, which occurs in approximately 5-10% of patients [11][12][13]. Unlike cases with bone marrow involvement, however, HL with clinically symptomatic bone involvement has been associated with similar or slightly better prognoses than those of patients with lymph node disease alone [14].…”

A unique bone marrow lymphoma patient presenting with an isolated mass: A case report

“…Lymphoma is a malignant tumor that typically manifests progressive lymph nodes enlargement without pain and occasionally, the liver, bone and bone marrow may be involved (1). Lymphoma with bone marrow involvement is not rare (2).…”