Lymphoma and plasma cell neoplasms
B cell disorders
Bone marrow biopsy

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 3 April 2017, last major update February 2011

Copyright: (c) 2001-2017, PathologyOutlines.com, Inc.

PubMed Search: bone marrow biopsy lymphoma

Cite this page: Bone marrow biopsy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphomabcellmarrowbiopsy.html. Accessed May 22nd, 2017.
Definition / general
  • 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
  • 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 clinically 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)
Microscopic (histologic) description
  • 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 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 nonspecific
Microscopic (histologic) images

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Persistant polyclonal
lymphocytosis may
mimic lymphoma

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