Clinicopathological Study of Marrow Infiltration by Lymphoproliferative Disorders: A 2-year Experience from a Cancer Institute

AbstractBone marrow (BM) examination is an essential tool in evaluation and staging of non-Hodgkin lymphoma (NHL). The aim of this study is to overview the approach to the use of unilateral versus bilateral BM sampling in lymphoproliferative disorders for diagnosis and staging. All cases diagnosed as lymphoproliferative disorders from January 2014 to January 2017 were studied. Bilateral trephine biopsy and aspiration of 414 cases were assessed for involvement patterns and presence/absence of background changes. Bone marrow involvement (BMI) was seen in 109 (26.3%) cases. The cases ranged from 2 to 80 years. BMI was more frequent in B-cell lymphomas than T-cell lymphomas as was the incidence (B-NHL= 87/109 [79.8%]; T-NHL=21/109 [19.1%]). Among B-cell lymphomas, BMI was most frequent in chronic lymphocytic lymphoma followed by B-lymphoblastic lymphoma (BLL) and mantle cell lymphoma. Among T-cell lymphomas, BMI was most frequent in T-lymphoblastic lymphoma (TLL). A single case of anaplastic large cell lymphoma (ALCL) had BMI. Bone marrow aspiration (BMA) and bone marrow trephine (BMT) agreed in 97% of cases (401 of 414: 308 both negative, 93 both positive). Additional 13 cases were diagnosed on BMT whereas BMA was negative for these cases. Background changes (fibrosis and necrosis) were common in TLL followed by BLL. Of the 109 positive cases, 4 were missed by unilateral BMT. Peripheral spill of lymphoma was seen in 14 of 109 cases. BMT involvement by lymphoma is more commonly seen in lymphoblastic lymphoma. Bilateral trephine biopsy remains gold standard to determine the marrow involvement and staging and assess the remission.