Intrasinusoidal bone marrow infiltration and splenic marginal zone lymphoma: a quantitative study

Abstract

: Intrasinusoidal infiltration (ISI) is a pattern of invasion that is rarely found on bone marrow (BM) biopsies, and is considered as a hallmark of splenic marginal zone cell lymphoma (SMZL). We analysed BM biopsies showing intrasinusoidal infiltration from 54 consecutive patients with different types of lymphoma to verify if ISI quantity was a diagnostic criterion for SMZL. There were 35 primary splenic lymphoma (PSL) and 19 non‐PSL; 28 SMZL, three non‐splenic MZL, six mantle cell, six small lymphocytic, four follicular, four diffuse large B cell, one peripheral T cell, one lymphoplasmacytic and one anaplastic large‐cell lymphoma. The quantity of BM infiltrate was assessed on CD45, CD20 and CD3 stained sections. The mean percentage of total (TI) and intrasinusoidal (ISI) lymphocytes was calculated in 10 areas for each case. TI quantity was 21.57 in PSL and 35.05 in non‐PSL (P = 0.04). ISI quantity was 5.23 in PSL and 7.62 in non‐PSL (P = 0.08), 5.83 in SMZL and 2.83 in other types of PSL (P = 0.12), 4.46 in non‐splenic MZL and 8.21 in other types of non‐PSL (P = 0.28). No difference in ISI quantity was found among the lymphoma subtypes, either in PSL (P = 0.74) or non‐PSL (P = 0.3). The data demonstrate that ISI quantity in BM biopsies is not a reliable diagnostic parameter for SMZL.

Outline for Writing an Article for Current Treatment Options in Oncology: Splenic Lymphoma with Villous Lymphocytes

“…Infiltration of the bone marrow is evident in all patients: the pattern of marrow infiltration may be nodular, interstitial or diffuse. Intrasinusoidal lymphoma cells are characteristic in SLVL [10] and are not a specific and reliable diagnostic parameter for SLVL [11].…”

Extranodal and splenic small B-cell lymphoma

“…58 In the bone marrow, intrasinusoidal infiltration is not restricted to SMZL and may be seen in many other types of small B-cell lymphoma, particularly those with splenic involvement. 59 Mantle cell lymphoma presenting with massive splenomegaly and a leukaemic phase shows typical morphology but may be associated with a more indolent course with initial response to splenectomy alone and delayed requirement for chemotherapy. 60 A variant of mantle cell lymphoma where the cells are larger and the nuclei are round with small central eosinophilic nucleoli has been described which does not correspond to either of the conventionally recognised blastoid or pleomorphic variants.…”

Advances in the diagnosis and management of lymphoma

“…Within the bone marrow, a characteristic pattern of intrasinusoidal infiltration is considered a hallmark of the disease. 174 Lymphadenopathy is typically absent or low in volume. 175 A minority of patients are infected with hepatitis C virus, and treatment of the infection seems to improve tumor burden in infected patients, though the interaction may be mediated by associated cryoglobulinemia.…”