Challenges in bone marrow pathology

Abstract

Bone marrow diagnosis presents unique challenges: distinction between benign and neoplastic conditions may be subtle and the pathologist must effectively incorporate information from several morphologic modalities (trephine biopsy, aspirate smear, peripheral blood smear) as well as a myriad of ancillary testing results. In this Short Course, several difficult diagnostic scenarios will be explored using actual clinical cases that illustrate key points in the differential diagnosis of bone marrow diseases. These will include hypocellular bone marrow (in which distinction between hypoplastic myelodysplastic syndrome and aplastic anemia may be difficult), fibrotic bone marrow, and marrow lymphoid infiltrates, with discussion of both B-cell and T-cell lymphomas. Hypercellular bone marrow raises distinct differential diagnoses depending on whether the patient is cytopenic or presents with elevated counts, and can reflect a myeloid neoplasm or various reactive conditions in either situation. An accurate diagnosis relies on understanding the spectrum of diseases that can produce specific patterns in the bone marrow and awareness of clues that help distinguish among the differential diagnostic possibilities. Depending on the clinical context, the pathology may variably weigh morphology, clinical information, and ancillary test results in arriving at the final diagnosis.