Reactive and neoplastic lymphocytes in human bone marrow: morphological, immunohistological, and molecular biological investigations on biopsy specimens.

Abstract

Background-Slight, diVuse or focal lymphocyte proliferation is relatively common in bone marrow biopsy specimens. It may be impossible to determine whether this represents a reactive lymphocytosis or low grade non-Hodgkin lymphoma (NHL) on the basis of routine investigations alone. Aim-To investigate the supplementary use of molecular biological techniques in this situation. Methods-529 formalin fixed, paraYn embedded bone marrow biopsy specimens from the iliac crest were subjected to histological and immunohistochemical staining to determine the number and nature of the lymphocytes present. The cases were divided into three groups according to the lymphocyte count: normal (< 10% of nucleated bone marrow cells), slightly increased (10-30%), and markedly increased(> 30%). All of the last group could be diagnosed as NHL from the morphological findings alone. The clonality of rearrangements of the IgH and TCR genes was investigated by polymerase chain reaction (PCR). Results-Monoclonality was observed in 7.5% of the 372 cases with a normal lymphocyte count, in 50% of the cases with a modest increase in lymphocyte numbers (suggesting a diagnosis of low grade NHL not detected by immunostaining), and in 77% of the cases with markedly increased lymphocyte numbers. Conclusions-If PCR is used in addition to the immunohistochemical investigation of bone marrow biopsies, considerably more cases of NHL can be identified, making this of particular use in staging and detection of recurrences. (J Clin Pathol 1999;52:521-526)

PCR Analysis of IgH and TCR-γ Gene Rearrangements as a Confirmatory Diagnostic Tool for Lymphoproliferative Disorders

“…In such cases, complementary diagnostic techniques like molecular clonality assays with analysis of IgH gene rearrangements are recommended [3,6,7].…”

“…However, histopathological examination is already considered as the gold standard in primary diagnosis and classification of NHLs. Clonality assessments are particularly helpful in establishment of definite diagnosis of such malignancies [6,7]. Moreover, even in cases where molecular assays are not a prerequisite for definite diagnosis, assessment of clonality may be useful in disease follow-up by identifying a tumor-specific marker.…”

Extranodal marginal zone B cell lymphoma of MALT type involving the mucosa of both the urinary bladder and stomach

“…Extracted DNA was examined by the polymerase chain reaction (PCR) for immunoglobulin heavy chain gene (IgH) rearrangements 8 and the translocation t(14;18)(q32;q21). 9 Purified PCR products were cloned and sequenced.…”

Biopsieindikationen

“…Es finden sich breite, konfluente Osteone welche für die hohe Dichte des Knochengewebes verantwortlich sind. Die hämatopathologische Begutachtung einer Jamshidi-Punktion bei rheumatologischen Fragestellungen konzentriert sich meistens auf die Bewertung reaktiver Lymphozytosen und deren Abgrenzung zu Lymphomen [23]. Eine Vermehrung hämosiderinspeichernder Makrophagen in den Markräumen kann als Äquivalent einer sog.…”

“…Diese zeichnen sich typischerweise durch eine intertrabekuläre Position mit erhöhtem Anteil CD3-positiver Das Wesen der Osteoporose besteht histopathologisch in einer reduzierten intratrabekulären Vernetzung sowie in einer Durchmesserreduktion der Trabekel Die Osteomalazie ist eine systemische Knochenstoffwechselerkrankung, welche auf einer gestör-ten Mineralisation der organischen Knochenmatrix basiert Tritt die Osteomalazie vor dem Epiphysenschluss auf, wird sie als Rachitis bezeichnet Die hämatopathologische Begutachtung einer Jamshidi-Punktion konzentriert sich auf die Bewertung reaktiver Lymphozytosen und deren Abgrenzung zu Lymphomen CME Lymphozyten aus. Peritrabekuläre, CD20-prädominante Infiltrate mit erhöhtem Retikulinfasergehalt können an die Differenzialdiagnose einer Knochenmarkinfiltration durch ein B-Zell-Lymphom denken lassen [23]. Plasmozytominfiltrate zeichnen sich durch eine überwiegend diffuse Vermehrung zytologisch atypischer Plasmazellen in den Knochenmarkräumen aus.…”