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Lymphoma - B cell neoplasms

Bone marrow biopsy


Reviewer: Nikhil Sangle, M.D., University of Utah and ARUP Laboratories (see Reviewers page)
Revised: 2 February 2011, last major update February 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

General
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● See also individual B cell lymphoma topics
● Overall incidence of marrow involvement at diagnosis of B cell lymphoma is 40-55% in adults, varies from 20% (MALT lymphoma) to 80% (splenic marginal zone / mantle cell lymphoma)
● Usually less than half of marrow is involved, particularly in SLL and follicular center cell lymphoma
● Discordance of marrow and nodal lesions may be due to (a) different clones, (b) a benign lesion at one site or (c) post-antibody therapy

Prognostic factors
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● Presence of small, incidental, clonal B cell populations in peripheral blood or marrow often is NOT associated with subsequent lymphoma, at least within a few years (Am J Clin Pathol 2004;122:588); recommended to compare PCR products from marrow and primary lymphoma to avoid detection of clinically irrelevant clonal populations (Hum Pathol 2000;31:847)
● Histologically and clnically benign lymphoid aggregates may have clonal IgH rearrangement, particularly in patients with autoimmune disorders (Hum Pathol 2007;38:1402)
● In post-transplant lymphoproliferative disorder, combination of elevated lactate dehydrogenase (>225 U/L) and decreased hemoglobin (<10 g/DL) is suggestive of marrow involvement and the need for marrow biopsy (Hum Pathol 2010;41:1150)

Micro description
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● Patterns of involvement are diffuse, focal paratrabecular, focal nonparatrabecular, interstitital and intrasinusoidal
● Focal paratrabecular pattern suggests follicular center cell lymphoma (Am J Surg Pathol 2005;29:1549)
● Interstitial pattern means marrow architecture is preserved but tumor infiltrates interstitium of marrow; may appear normal on low power, commonest pattern of marrow involvement in CLL
● Intrasinusoidal pattern is difficult to identify without special stains (CD20)
● Intravascular pattern is rare, may represent persistant polyclonal lymphocytosis (Mod Pathol 2004;17:1087)
● Another rare pattern is recapitulating nodal involvement by neoplasm
● Predominant cell type in marrow is usually similar to that in lymph node, particularly for Burkitt’s lymphoma and T cell lymphoma; may be discordant for follicular lymphoma (marrow-small cleaved cells; lymph node-large cells or mixture of large and small cells)
● Clusters of benign B or T cells may be present (Am J Clin Pathol 2007;128:974)
● Granulomas are common and non-specific

Micro images
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Persistant polyclonal lymphocytosis may mimic lymphoma

Immunohistochemistry
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● Important to determine cell type involved, extent of tumor involvement, presence of post-treatment residual disease and whether it has same lineage/phenotype as pre-treatment disease
● Aberrant CD8+ expression in 2% (Am J Clin Path 2009;132:186)

End of Lymphoma - B cell neoplasms > Bone marrow biopsy


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