Abstract
Lymphoid aggregates are seen in a minority of bone marrow biopsy specimens, and when present, their neoplastic nature is often apparent by morphologic evaluation. However, the distinction between benign and malignant aggregates can be a diagnostic challenge when there are multiple aggregates with no documented history of lymphoma. To aid in the distinction between benign and malignant B-cell lymphoid aggregates. Previously, we described specific distribution patterns for B and T lymphocytes within bone marrow aggregates. To statistically analyze the significance of these patterns as well as previously reported criteria, we examined 128 bone marrow specimens with benign aggregates and 78 specimens with documented malignant B-cell aggregates and calculated specific odds ratios (ORs) and 95% confidence intervals (CIs) to aid in differentiating between benign and malignant B-cell aggregates. Aggregates with infiltrative edges (OR, 80.54; 95% CI, 31.76-204.21), a B-cell pattern (OR, 30.08; 95% CI, 13.28-68.10), paratrabecular location (OR, 10.17; 95% CI, 3.96-26.12), size greater than 600 μm (OR, 6.83: 95% CI, 3.61-12.93), or cytologic atypia correlated with malignancy. When taken collectively, the presence of more than 2 of these characteristic features was strongly predictive of malignancy.
Highlights
Title Differentiating benign from malignant bone marrow B-cell lymphoid aggregates: a statistical analysis of distinguishing features
Context.—Lymphoid aggregates are seen in a minority of bone marrow biopsy specimens, and when present, their neoplastic nature is often apparent by morphologic evaluation
Design.—Previously, we described specific distribution patterns for B and T lymphocytes within bone marrow aggregates
Summary
It has been reported that benign lymphoid aggregates tend to have a nonparatrabecular location, distinct borders without interstitial spillage of lymphoid cells, and are typically small (,600 lm).[1,2] Malignant characteristics of lymphoid aggregates include predominance of B cells, infiltrative edges, paratrabecular location, inclusion of fat cells, location surrounding large sinuses, and large aggregates.[1,2,3,4,5] the loss of benign aggregates in deeper sections is considered a prominent indicator of a benign process.[6,7] In a previous study,[8] we demonstrated distinct immunomorphologic patterns of B and T cells in benign and malignant aggregates Associations between these various characteristics, including the distribution patterns of B and T lymphocytes, and the risk of a B-cell lymphoma in patients who have these bone marrow findings, have not been quantified. We extend our observations by examining the different morphologic and immunophenotypic characteristics of a large number of both benign and malignant bone marrow lymphoid aggregates and apply statistical tools to validate previously proposed criteria for the distinction between benign and malignant B-cell aggregates
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