scholarly journals Clinically Undetected Hodgkin Lymphoma Diagnosed Initially on Bone Marrow Biopsy: A Large Retrospective Observational Study from a Tertiary Care Center

2021 ◽  
Vol 42 (06) ◽  
pp. 554-560
Author(s):  
Navatha Vangala ◽  
Tara Roshni Paul ◽  
Shantveer G. Uppin ◽  
Megha S. Uppin ◽  
G. Sadashivudu ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
Hodgkin Lymphoma ◽  
Bone Marrow Biopsy ◽  
Care Center ◽  
Tertiary Care ◽  
Lymph Node Biopsy ◽  
Common Symptom ◽  
Mixed Cellularity ◽  
Loss Of Weight

Abstract Introduction Hodgkin lymphoma (HL) involving the bone marrow (BM) is relatively rare with an incidence ranging from 4% to 18%. The incidence of primary HL of marrow is 0.25%. To the best of our knowledge, the present study is the largest study on HL diagnosed initially on marrow biopsy. Objective To establish diagnostic criteria based on clinicopathological and histological features in HL diagnosed first on the marrow. Materials and Methods This was a retrospective study done from January 2012 to December 2020 that included 36 cases of HL diagnosed initially on BM. Based on the presence of large mononuclear or binucleate Reed–Sternberg (RS)-like cells in a polymorphous inflammatory background, HL was suspected and immunohistochemistry (IHC) with CD15 and CD30 was done. Correlation with subsequent lymph node biopsies was done, wherever possible. Results Fever (94.4%) was the most common symptom, followed by loss of weight (66.7%). Twenty-one cases (58.4%) had uni/bicytopenia and 15 cases (41.6%) had pancytopenia. Only one case showed suspicious mononuclear RS cells on aspirates and the rest of the cases were diagnosed on trephine biopsy alone. Trephine imprints showed variable cellularity in 13 (36%) cases. Diffuse involvement was seen in 24 cases (66.7%), and focal nodular aggregates were seen in 12 cases (33.3%). Out of 36 cases, 26 cases (19 cases on marrow and 7 cases on lymph node) were confirmed as HL with IHC. Immunophenotype of the RS cells on the marrow was CD30+/CD15+ in (6/29) (20.7%) cases, CD30+/CD15− in (7/29) (24.1%) cases and CD30−/CD15+ in (6/29) (20.7%) cases. Seven cases (26.9%) were diagnosed on subsequent lymph node biopsy as mixed cellularity HL with IHC confirmation. Marrow fibrosis was seen in 16 cases (44.4%), and granulomas were seen in 8 cases (22.2%). Conclusion In cases presenting with long-standing fever and cytopenias, HL must always be suspected, even if there are no palpable lymph nodes. Bone marrow biopsy is preferable over aspiration in such cases and IHC plays a major role in diagnosing the cases.

scholarly journals Follow-up of Patients with Atypical Lymphoproliferation in Bone Marrow or Lymph Node Biopsy

Acta Medica ◽  
2021 ◽  
pp. 1-6
Author(s):  
Rafiye Ciftciler ◽  
Ali Erdinc Ciftciler ◽  
Emine Arzu Saglam ◽  
Yahya Buyukasik
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
Hodgkin Lymphoma ◽  
Bone Marrow Biopsy ◽  
Primary Immunodeficiency ◽  
Lymph Node Biopsy ◽  
Lymphocytic Leukemia ◽  
University Hospital ◽  
Node Biopsy

Objective: Patients presenting with various complaints to the hematology polyclinic may initially be diagnosed with an atypical lymphoproliferation in bone marrow or lymph node biopsy. The aim of this study was to determine whether a hematological disease, immunodeficiency syndrome, or other diseases were diagnosed during follow-up of patients with an initial diagnosis of atypical lymphoproliferation in bone marrow or in lymph node biopsy. Materials and Methods: Adult (≥18 years) patients who were admitted to the Hacettepe University Hospital, for various symptoms between 2002 and 2018 were searched for in our hematology department electronical database. Results: A total of 52 patients were found with atypical lymphoproliferation in lymph node or bone marrow biopsy. The patients had been followed for a median of 9.2 months (0.03-86.2). Hematological neoplasia developed in 32 (61.6%) of the 52 patients and primary immunodeficiency was detected in 6 (11.5%) of the 52 patients. Twenty-six patients (50%) were diagnosed Non-Hodgkin lymphoma during follow up, 1 patient (1%) was diagnosed chronic lymphocytic leukemia, 5 patients (9.6%) were diagnosed Hodgkin lymphoma and 6 patients (11.5%) were diagnosed primary immunodeficiency. Median time was 2.3 months (0.2-25 months) between atypical lymphoproliferation report in bone marrow or lymph node biopsy and the diagnosis of patients. Conclusion: In conclusion, patients who have atypical lymphoproliferation in the lymph node or bone marrow biopsy should be followed up in the hematology outpatient clinic. Because, during follow-up, diseases such as hematological neoplasia or immunodeficiency can be diagnosed in patients with atypical lymphoproliferation.

scholarly journals Significant Variability in the Initial Workup of Thrombocytopenia in the Hematology Clinic - What Is the "Optimal" Workup?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5966-5966
Author(s):  
Aishwarya Ravindran ◽  
Ronald S. Go ◽  
Kaaren K. Reichard ◽  
Ariela L. Marshall
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Large Scale ◽  
Hepatitis A Virus ◽  
Conflicts Of Interest ◽  
Medical Condition ◽  
Care Center ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
Target Cells

Abstract BACKGROUND: Thrombocytopenia is a common hematologic condition associated with multiple etiologies ranging from benign to malignant to potentially life-threatening disorders. Given the heterogeneity of clinical presentations, available clinical information, and pertinent clinical history, there are inter-physician variations in the approach to the workup of thrombocytopenia in the hematology clinic. While a limited test repertoire may be adequate for many cases, more extensive testing may be warranted in others. We were interested in analyzing the various tests performed and testing approaches in the initial workup of thrombocytopenia. METHODS: We reviewed the records of 69 patients who were referred to our center between 2010 and 2015 for an initial workup of thrombocytopenia. We collected epidemiologic data, laboratory testing results, and pathologic findings. Pathologic results were classified as "normal" or "abnormal" and further subcategorized on the basis of review by two clinicians. Quantitative data were analyzed using JMP Pro 10.0.2 software. RESULTS: At the time of thrombocytopenia diagnosis, the median age was 59 years (range: 17-90) and majority were males (65%). The median platelet count was 91,000/µL (range: 3,000-146,000). Isolated thrombocytopenia was present in 51 cases (74%). Forty-four patients (64%) had a peripheral blood smear review and 4 (9%) contained abnormalities including hypogranular neutrophils, rouleaux formation, and target cells. Autoimmune workup included anti-platelet antibody (APA) in 34 (49%), anti-nuclear antibody (ANA) in 21 (30%), lupus anticoagulant (LA) in 4 (6%) and rheumatoid factor (RF) in 13 (19%) of cases. Autoimmune testing was positive for APA in 2 (5.9%), ANA in 4 (19%), LA in 0 (0%), and RF in 1 (8%) of patients who underwent testing, respectively. Common infectious workups included human immunodeficiency virus in 23 (33%), hepatitis A virus in 2 (3%), hepatitis B virus in 11 (16%), hepatitis C virus in 22 (32%), Epstein-Barr virus in 5 (EBV, 7%), cytomegalovirus in 7 (10%) and Helicobacter pylori in 5 (7%) of patients, and were negative in all cases except for one patient with evidence of active EBV infection. Sixteen patients (23%) underwent bone marrow biopsy, and 2 (12.5%) were diagnosed with hematologic malignancies including myelodysplastic syndrome and hairy cell leukemia. Based on results of these tests, 28 (41%) patients were diagnosed with primary immune thrombocytopenia, 19 (27%) with thrombocytopenia secondary to another medical condition, and 22 (32%) with thrombocytopenia of undefined etiology. CONCLUSION: Thrombocytopenia is a common laboratory finding, and workup involves significant inter-clinician variation, often involving multiple laboratory tests and in some cases invasive tests such as bone marrow biopsy. We found that autoimmune causes of thrombocytopenia were moderately common and infectious and malignant causes were rare. Our findings were based on a small cohort of patients but are likely to be representative of the clinical practice in a large tertiary care center. Large scale studies may be warranted to devise a protocol for a thorough yet cost-effective and stepwise initial workup of thrombocytopenia and to minimize unwarranted inter-clinician variation in such investigations. Disclosures No relevant conflicts of interest to declare.

Thalidomide: An Active Agent in AILT Lymphoma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4960-4960
Author(s):  
Ross Henderson ◽  
David Simpson ◽  
Merit Hanna ◽  
Sanjeev Chunilal
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
Bone Marrow Biopsy ◽  
Poor Prognosis ◽  
Case Reports ◽  
Lymph Node Biopsy ◽  
Red Cell ◽  
Red Cell Aplasia ◽  
Node Biopsy ◽  
Systemic Symptoms

Abstract Angioimmunobalstic T cell lymphoma (AILT) is a relatively rare subtype of lymphoma, accounting for approximately 1 – 2% of all cases of NHL. The pathogenesis is thought due to clonal expansion of follicular T-helper cells which subvert normal germinal centre function. It is characterised by systemic disease and significant immune dysregulation with frequent atypical infections and autoimmune disease. It has a poor prognosis with a median survival of less than 3 years using CHOP or CHOP-like regimens. Dose intensification, or anthracycline use, appears to be ineffective. Thalidomide is an immunomodulatory agent with isolated case reports of activity in this disease. We report 3 cases of AILT where thalidomide was effective at inducing or providing a sustained remission. Case 1 was an 86 year old woman who presented with systemic symptoms, widespread lymphadenopathy and a polyclonal increase in immunoglobulins. AILT was diagnosed from both lymph node biopsy and bone marrow biopsy. Symptoms improved only temporarily with prednisone. She commenced thalidomide at 200mg daily with improvement in symptoms and resolution of lymphadenopathy and after 2 months the dose was reduced to 100mg daily. She continued the thalidomide at the same dose and remained in remission until her death from unrelated causes 4 years later Case 2 was a 72 year old man who initially presented with autoimmune haemolytic anaemia and red cell aplasia which was unresponsive to steroids, intravenous immunoglobulins (IVIG), cyclosporine and splenectomy. He then developed cervical and axillary lymphadenopathy, biopsy of which showed AILT. Bone marrow examination showed no evidence of AILT. He commenced thalidomide at 150mg daily with resolution of the haemolysis and red cell aplasia within 12 days and reduction in all lymphadenopathy. He remains in remission 3 months after commencing thalidomide and is currently on 100mg daily. Case 3 was a 57 year old woman presented with ITP with platelets < 10, systemic symptoms, widespread lymphadenopathy and hepatosplenomegally. AILT was diagnosed from lymph node biopsy and bone marrow biopsy. She commenced on prednisone and IVIG for the ITP, then proceeded to CHOP chemotherapy. Her first cycle was complicated by Pneumocystis jirovecii infection. Following the chemotherapy, her systemic symptoms subsided and the lymphadenopathy and organomegaly resolved. She commenced thalidomide at 100mg daily and has remained in remission 2 months later. There are now several case reports in the literature indicating that thalidomide is effective in AILT which is reflected by the cases reported here. Given the poor prognosis of AILT using conventional chemotherapeutic regimens, such as CHOP, prospective clinical trials using thalidomide, or the newer derivatives such as lenalidomide, are warranted.

scholarly journals MYELOFIBROSIS ASSOCIATED WITH TUBERCULOSIS

Blood ◽  
1948 ◽  
Vol 3 (12) ◽  
pp. 1426-1444 ◽  
Author(s):  
HOWARD W. CRAIL ◽  
HOWARD L. ALT ◽  
WALTER H. NADLER
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
Bone Marrow Biopsy ◽  
Similar Type ◽  
Pathologic Study ◽  
Loss Of Weight ◽  
Lymph Node Enlargement ◽  
Autopsy Examination

Abstract Myelofibrosis (fibrotic bone marrow and, usually, an increase in megakaryocytes) is characterized by generalized pains, weakness, loss of weight, enlargement of the liver and spleen and a leuko-erythroblastic anemia. Four cases of myelofibrosis associated with generalized tuberculosis have been reviewed in detail. Autopsy examination of the 4 cases revealed acute, caseating tuberculosis which was considered to be responsible for the bone marrow and generalized fibrosis observed. A similar type of tuberculosis occurred in 7 of 91 cases of myelofibrosis reveiwed in the literature. The pathogenesis of myelofibrosis associated with tuberculosis is discussed. In the diagnosis of this syndrome, attention is called to the importance of obtaining a bone marrow biopsy and making a complete bacteriologic and pathologic study of this tissue for tuberculosis. The 4 tuberculous cases here reported as compared with 5 cases of idiopathic type, are younger, have hyperpyrexia, less splenic but greater lymph node enlargement and run a shorter course before death.

scholarly journals Clinical profile and etiological causes of pancytopenia: a study in a tertiary care hospital

2019 ◽  
Vol 6 (5) ◽  
pp. 1379
Author(s):  
Lavanya Mandli
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Peripheral Blood ◽  
Megaloblastic Anemia ◽  
Tertiary Care ◽  
Survival Rates ◽  
Invasive Procedure ◽  
Common Symptom ◽  
Care Hospital ◽  
X Rays

Background: Pancytopenia is a condition which involves the presence of anemia, leucopenia and thrombocytopenia. Symptoms of pancytopenia include fatigue, bleeding, dyspnea, and increased tendency to infections. The evaluation of pancytopenia is by complete blood picture and peripheral blood smear including that of reticulocytes. Bone marrow examination is extremely helpful.Methods: Demographic details were collected from all the patients and  physical examination was done. The patients were asked to undergo biochemical investigations, chest X rays and USG of abdomen. Smears were taken from peripheral blood as well as bone marrow biopsy and stained. Invasive procedure such as bone marrow biopsy is done if needed.Results: A predominance of males was seen over females and 11-30 years age group was the most affected. The most common cause was megaloblastic anemia followed by aplastic anemia and tuberculosis. The most common symptom were fatigue, dyspnea, fever and bleeding.Conclusion: Early identification of this disease would help in early planning for management thereby improving the survival rates.

scholarly journals A Case Report: Angioimmunoblastic T Cell Misdiagnosed as Pulmonary Sarcoidosis

2021 ◽  
Author(s):  
xuerui Wang ◽  
Xu jie ◽  
Chen guang ◽  
bingyan Zhan
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
T Cell ◽  
Bone Marrow Biopsy ◽  
Cell Lymphoma ◽  
Clinical Manifestations ◽  
Pulmonary Sarcoidosis ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
History Of

Abstract Introduction: Angioimmunoblastic T-cell lymphoma is a peripheral T-cell lymphoma subtype characterized by abnormal proliferation of T lymphocytes with hyperplasia of endothelial veins and follicular dendritic cells. Sarcoidosis is a non-caseating epithelial granulomatous disease of unknown cause, which can invade the whole body organs, especially the lungs and intrathoracic lymph nodes. The clinical manifestations are not specific. There are many similarities between the malignant lymphoma and pulmonary sarcoidosis in the early clinical manifestations, such as chest imaging and clinical manifestations, which are easy to be misdiagnosed. Methods: A fifty-three-year-old man presented with a two-month history of cough. This article uses the clinical data of a patient to reveal the main points that should be paid attention to in the diagnosis of lymphoma.Results: The patient were given right inguinal lymph node biopsy and bone marrow biopsy. Case Presentation: Here, A fifty-three-year-old man presented with a two-month history of cough. The effect was not good after one week of anti-infective and glucocorticoid treatment. Lymph node biopsy and bone marrow biopsy were performed. Conclusion: When we find that the therapeutic effect of pulmonary sarcoidosis is not good, we should make pathological diagnosis. We can prevent further deterioration of the disease through the above measures.

GENERALIZED LYMPHADENOPATHY AND HEPATOSPLENOMEGALY INDUCED BY DIPHENYLHYDANTOIN

PEDIATRICS ◽  
1961 ◽  
Vol 28 (6) ◽  
pp. 943-945
Author(s):  
Mehdi Bajoghli
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
Drug Therapy ◽  
Biopsy Specimen ◽  
Lymphoid Hyperplasia ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Generalized Lymphadenopathy

A 6-year-old child developed generalized lymphadenopathy and hepatosplenomegaly 2 weeks after diphenylhydantoin therapy was begun. The patient recovered 4 weeks after discontinuance of the drug therapy. There was eosinophilia in blood and in bone marrow, and a lymph node biopsy specimen showed reticulum and lymphoid hyperplasia.

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