Incidence Of Marrow Involvement Research Articles

Study of Staging and Prognostic Significance of Bone Marrow Involvement in Malignant Lymphomas in Northern India : Clinicopathological Study

Introduction: Bone marrow is not only a reservoir of stem cells but also provides microenvironment for proliferation and development of precursors and regulate the release of mature cells in to circulation. Bone is commonly involved in metastatic tumors and rank third most common site of metastasis after lung and liver. Metastasis may be present in the bone marrow without any abnormalities recognized in bone scans, radiographic pictures, serum chemistry and hematological parameters and remain the only procedure to diagnose the presence of metastatic tumor. AIMS: To study the clinical features&characteristics of BM involvement in NHL& HL cases with respect to morphology of infiltration for staging and their prognosis. Materials and Method: A prospective study was conducted on 38cases who had not received any prior specific treatment (chemotherapy and radiotherapy) for both Hodgkin's and non-Hodgkin's lymphoma from northern India, . Out of 38 cases Hodgkin's lymphoma were 08 cases and non- Hodgkin's lymphoma were 30 cases . All cases were examined clinically and later on Bone marrow aspiration and Bone marrow biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. The smears were air dried and immediately fixed in methanol for one of the Romanowsky stain (We used Leishman stain and May-Grunwald Geimsa stain) for cellularity and morphology1. Serial aspiration and biopsies were done in all cases of Hodgkin's and non-Hodgkin's lymphoma Observations: The most prominent clinical feature was cervical lymphadenopathy. Patients with advanced disease had systemic features like fever, weight loss and hepatosplenomegaly. The incidence of marrow involvement in known case of Hodgkin's and non-Hodgkin's lymphoma was 25% and 43.33% respectively. The incidence of bone marrow involvement was found in mixed cellularity and in lymphocyte depletion type of Hodgkin Lymphoma cases and the pattern of involvement of bone marrow was diffuse in all the cases. The extent of marrow involvement was greatest in Non Hodgkin lymphomas that exhibit a diffuse pattern of infiltration. In thirteen cases (43.33%) of bone marrow involvement, seven cases (53.8%) showed presence of neoplastic cells in both aspiration and biopsy while six cases (46.2%) showed presence of neoplastic cells in bone marrow biopsy. Serial aspiration and biopsies revealed that both cases (100%) of Hodgkin's lymphoma improved with systemic chemotherapy, while five cases (38.46%) of non-Hodgkin's lymphoma showed clearance of bone marrow by the neoplastic cells on completion of chemotherapy. Conclusion: In all the cases, which infiltrated to bone marrow, histological grades were same as in the FNAC / Histopathology examination at the time of diagnosis from the primary site. Bone marrow aspiration and biopsy were performed as complimentary procedures. But Bone marrow biopsy was found superior to bone marrow aspiration.. It was also helpful in the management strategy of the disease as well as to see the response of the therapy by serial aspiration and biopsies10. It was found that in five cases (38.46%) of non-Hodgkin's lymphoma bone marrow showed clearance of tumor cells after completion of chemotherapy.

Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study

Bone marrow (BM) biopsy is an integral part of staging work-up for non-Hodgkin lymphoma (NHL). To study the characteristics of BM involvement in NHL with respect to incidence, histologic pattern and morphology of infiltration and its discordance with the histology of primary anatomic site. Forty-nine cases of NHL in which BM biopsy was performed for staging were included in this study, the primary site being classified according to the WHO classification for NHL. A prospective study of 49 cases was conducted. Bilateral BM biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. BM biopsy showed involvement by lymphoma in 27 cases (55.10%). Unilateral positivity was found in four cases (14.81% cases). The overall incidence of marrow involvement by NHL was 55.1%. The incidence of involvement was higher in T-cell lymphomas when compared with B-cell lymphomas and predominant pattern of involvement was mixed. Diffuse large B-cell lymphomas had the lowest incidence in all the B-cell lymphomas. A discordant histology between BM and primary anatomic site was found in 29.63% (8/27) of the cases, where it was seen more in follicular lymphomas and diffuse large B-cell lymphomas. Critical examination of BM biopsies can increase the diagnostic accuracy, thereby contributing to the prognosis and appropriate treatment modalities.

Clinical relevance of bone marrow biopsy in staging and follow-up of breast cancer.

Bone marrow biopsies by Jamshidi needle were performed in 106 breast cancer female patients. Sixty-four of them were in follow-up after mastectomy, and neoplastic involvement of marrow was found in 21 patients (32.8%). Among the 42 women undergoing staging before mastectomy, the incidence of marrow involvement was 11.9% (5 women, all with radiographic positivity). Of the 37 women, either in follow-up or in the staging phase, with bone metastases detected by roentgenographic and isotopic examination, the bone biopsy was positive in 23 (62.1%), and 7 histologically had micrometastases. Three women, without any radiographic or isotopic sign of metastases, had positive biopsies. A good correlation was found between the hydroxyproline:creatinine ratio and neoplastic involvement of bone marrow.

Involvement of the bone marrow by non-Hodgkin's lymphomas: incidence, histology and pathologic correlations.

The Lukes and Collins system of classification was applied to 151 cases of non-Hodgkin's lymphoma who had bone marrow biopsies taken immediately after histologic diagnosis. Incidence and histologic pattern of bone marrow involvement at the time of initial diagnosis were determined for each subtype of lymphoma. Thirty-three patients (21.8%) had bone marrow involvement. The frequency of bone marrow involvement was high for undefined and convoluted lymphocyte lymphomas (66.6%) and low to intermediate for follicular centre cell (20.3%) and small lymphocyte lymphomas (20.0%). Within the FCC lymphomas the non-cleaved cell type had a higher incidence of marrow involvement than the cleaved cell type (41.6% vs 8.9%). The follicular and diffuse histologic patterns in the diagnostic node did influence the incidence of marrow invasion in the non-cleaved cell type (75% vs 25%). A low incidence of marrow involvement was observed for the immunoblastic lymphomas (14.2%); evidence of marrow infiltration was never observed in patients with true histiocytic lymphomas.

Non-Hodgkin's lymphomas. I. Bone marrow involvement.

Two hundred and eighteen untreated patients with non-Hodgkin's lymphomas, classified according to the scheme of Rappaport et al., were investigated for bone marrow involvement. No pattern of pretreatment laboratory abnormalities predicted which patients would have a positive bone marrow for lymphoma. Open marrow biopsy demonstrated lymphoma after needle biopsy was negative, and both biopsy techniques were clearly superior to bone marrow aspiration in identifying marrow involvement. Bone marrow involvement correlated with advanced stage, cellular composition of the lymphoma, and, in the nodular lymphomas, splenomegaly and constitutional symptoms. Patients with histiocytic lymphomas uncommonly had initial marrow involvement whereas patients with mixed and lymphocytic types were frequently affected. Nodular or diffuse patterns did not influence the incidence of marrow involvement, but patients with nodular lymphomas and positive marrows survived significantly longer than those with diffuse lymphomas.

An Evaluation of Paraffin Sections of Aspirated Bone Marrow in Malignant Lymphomas

Abstract Examination of serial paraffin sections of bone-marrow aspirations has increased the known incidence of marrow involvement in malignant lymphomas. The results of this study can be seen in the table. In the 72 cases reviewed here, lesions compatible with malignant lymphoma were seen in paraffin sections in 22 cases. In 12 cases this was the only material available for diagnosis at the time. In an additional seven cases paraffin sections were considered suggestive of malignant lymphoma and in five of these a diagnosis could be made on the basis of examination of both smear and paraffin section. This procedure is particularly helpful in Hodgkin’s disease and reticulum cell sarcoma, where marrow smears are only rarely diagnostic. In general, the patients in whom lesions were found in the bone marrow tended to have more advanced disease than those in whom lesions were not found, and abnormalities in the peripheral blood were more common. This was especially true of patients with Hodgkin’s disease, less so in those with reticulum cell sarcoma. Patients with lymphosarcoma, lymphocytic type, did not show this difference, either in the extent of the disease or in findings on examination of peripheral blood. Diagnosis was most difficult in patients who had lymphocytic lymphosarcoma, since it was occasionally difficult to distinguish between the benign aggregations of lymphocytes which are not infrequently found in a large number of unrelated conditions and those aggregations which represented malignancy. Differentiation was made on the basis of number of aggregations, degree of circumscription, presence or absence of reaction centers and the cytologic appearance of the cells. Examination of the smears of the marrow is most helpful in these cases. Seven patients in this series (9.7 per cent) had granulomatous lesions in the marrow. In five of these the final diagnosis was Hodgkin’s disease, in one reticulum cell sarcoma and in one follicular lymphoma. Although these lesions were not specific, the incidence is high enough to make the finding of a granuloma of some significance in any patient suspected of having malignant lymphoma. The importance of thorough examination of any material obtained in an apparent dry tap and the value of repeated marrow-examinations is emphasized by three cases in this series. Since in many cases diagnostic lesions are found in only one portion of the material, examination of only one section of the paraffin sections of aspirated bone marrow is not sufficient for proper evaluation. This fact is emphasized by the greater incidence of positive findings in this report than in that of Cooper and Watkins. Studies of bone marrow should be particularly helpful in instances in which the diagnosis of malignant lymphoma is suggested by clinical features but cannot be proved by biopsy of peripheral nodes or other readily accessible tissue.