Bone marrow trephine biopsy appearances of the intravascular subtype of diffuse large B-cell lymphoma

Introduction: In Non-Hodgkin Lymphoma (NHL), bone marrow histology is the gold standard against which ancillary investigations such as immunophenotyping and gene rearrangement studies are interpreted. There is currently no data on the reproducibility of histological findings. This study was conducted to determine the rates of inter- and intra-observer agreement in histological detection of bone marrow involvement in the two major subtypes of NHL, Diffuse Large B-cell Lymphoma (DLBCL), and Follicular Lymphoma (FL). Methods: The bone marrow slides of randomly selected DLBCL and FL cases were independently examined by two hematologists using standardized reporting criteria on two occasions at least two weeks apart. Samples included both aspirate and trephine biopsy slides. Weighted kappa statistics were used to examine agreement for the discrete measures. Results: Weighted kappa analyses showed variable inter-observer agreement in 38 DLBCL cases [aspirate=0.52; trephine= 0.77] and 38 FL cases [aspirate=0.48; trephine=0.77]. Conclusion: Overall, higher agreement rates were noted with trephine biopsies than with aspirates. Except for the high intra-observer agreement on trephine biopsy assessment in FL, there is poor agreement in histological staging of both FL and DLBCL which demonstrates the limitations of histological diagnosis and the futility of interpreting ancillary tests against histology.

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Bone Marrow Biopsy for the Staging of Diffuse Large B-Cell Lymphoma: Is It Necessary Bilateral Trephine Biopsy?.

Blood ◽

10.1182/blood.v110.11.4427.4427 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4427-4427

Author(s):

Marcelo Bellesso ◽

Rodrigo D. Velasques ◽

Luis F. Pracchia ◽

Beatriz Beitler ◽

Vera L. Aldred ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

Median Number ◽

Trephine Biopsy ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract In this retrospective analysis we study the usefulness of bilateral rather than unilateral iliac trephine biopsies in demonstrating Diffuse Large B-Cell Lymphoma (DLBCL) in the bone marrow (BM). A total of 28 DLBCL cases with BM infiltration were investigated with bilateral iliac trephine biopsy during staging. Our propose was to evaluate the incidence of unilateral BM involvement, and we compare the BM biopsy size with negative and positive BM infiltration. In 28 cases studied it was analyzed 70 BM fragments. These fragments were reviewed separately by pathologist about size and infiltration. In this group, 6 cases (21.4%) were unilaterally positive. The median number of fragment per case was 2.5; the median size of BM fragment was 11.01 mm (± 5.12) and BM fragment per case was 27.53mm. It was not found difference between size BM fragment in negative or positive fragments 11,57mm (±5.2) versus 10.95mm (±5.1), p>0.05, respectively. In 24 cases it was possible to compare negative and positive BM infiltration with age, sex, LDH and computerized tomography (CT) staging. In addition, it was not found difference between unilateral and bilateral BM infiltration about LDH and age, and CT. (Table 1). Conclusion: Although in unilateral infiltration cases did not change risk factor in International Prognostic Index (stage III–IV) by CT, we conclude that bilateral trephine biopsy is superior to unilateral, because bilateral biopsy could increase by 21,4% the detection of BM involvement by DLBCL, without difference between the size in negative versus positive fragments. Table 1. Distribution of Unilateral and Bilateral Bone Marrow infiltration by categories Unilateral infiltration (%) Bilateral infiltration (%) Age < 60 21% 50% Age ≥ 60 4% 25% Sex Male 16% 29% Sex Female 8% 47% CT staging I–II - 35% CT staging III–IV 26% 39% LDH Normal 8% 34% LDH Elevated 16% 42%

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Rare but Potentially Fatal Presentations of Diffuse Large B-cell Lymphoma: Leukemic Phase or Hemophagocytic Syndrome in Bone Marrow

Clinical Pathology ◽

10.1177/2632010x211070774 ◽

2022 ◽

Vol 15 ◽

pp. 2632010X2110707

Author(s):

Wan Awatif Wan Mohd Zohdi ◽

Ahmad Zulhimi Ismail ◽

Nurasyikin Yusof ◽

Azlin Ithnin ◽

Salwati Shuib ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Trephine Biopsy ◽

Large B Cell Lymphoma ◽

History Of ◽

Splenic Biopsy ◽

Atypical Presentations ◽

Large B Cell

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin Lymphoma commonly presenting as a solid tumor either by nodal or extra-nodal manifestations. Here we describe two atypical presentations of lymphoma, finally resulting in the diagnosis of DLBCL. Case 1: A 53-year-old man with a previous history of nasopharyngeal carcinoma presented with a two-week history of B-symptoms and hyperleukocytosis. Peripheral blood film showed 78% abnormal mononuclear cells. Immunohistochemical stain showing Ki-67 of 90%, negative c-myc, BCL2 and BCL6, and negative c-MYC with fluorescence in-situ hybridization studies on the trephine biopsy, concluded the diagnosis of CD5+ DLBCL of ABC subtype. He received intravenous cyclophosphamide and oral prednisolone for cytoreduction, followed by 6 cycles of chemo-immunotherapy. However, he succumbed due to severe sepsis after the completion of therapy. Case 2: A 56-year-old lady who was initially investigated for pyrexia of unknown origin was noted to have hemophagocytosis upon bone marrow aspirate examination. The bone marrow trephine biopsy revealed some atypical clusters of B-cells positive for CD20 which was inconclusive. PET-CT scan noted an enlarged hypermetabolic spleen without lymphadenopathy. Splenic biopsy with immunohistochemical studies revealed DLBCL of ABC subtype. The diagnosis was consistent with primary splenic DLBCL. She became unwell post splenic biopsy and was admitted to the intensive care unit where she passed away 2 weeks later from Candida and Sternotrophomonas septicemia. These cases highlight the atypical presentations of a common subtype of NHL in our center. Arriving at the definitive diagnosis can be difficult especially when patients are acutely ill, hampering the necessary invasive procedures for diagnosis. The outcomes of both cases are briefly discussed hoping to spread awareness among clinicians on the rare and acutely critical presentations of DLBCL.

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Bone Marrow Molecular Markers Associated with Relapsed/Refractory Activated B-Cell-Like Diffuse Large B-Cell Lymphoma

BioMed Research International ◽

10.1155/2018/1042597 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Di Wang ◽

Peng Liu ◽

Yue Zhang ◽

Hui-Ying Liu ◽

Di Shen ◽

...

Keyword(s):

Bone Marrow ◽

Molecular Markers ◽

B Cell ◽

Bone Marrow Aspirate ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Significant Finding ◽

Large B Cell Lymphoma ◽

Significant Difference ◽

Large B Cell

Activated B-cell-like diffuse large B-cell lymphoma (ABC-DLBCL) is a common subtype of non-Hodgkin’s lymphoma and is very likely to infiltrate the bone marrow. Over 30% of patients are converted to relapsed/refractory DLBCL after first-line rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, with a poor prognosis. Our aim was to identify molecular markers that might be utilized to predict relapsed/refractory ABC-DLBCL patients. Hence, we collected bone marrow aspirate smears from 202 patients with ABC-DLBCL and detected expression of bone marrow molecular marker proteins by immunocytochemistry. Signal transducer and activator of transcription (Stat)3, nuclear factor (NF)-κB p65, Syk, Bruton’s tyrosine kinase (BTK), and Bcl2 proteins were strongly expressed in bone marrow aspirate smears of ABC-DLBCL patients. The same smear could present positive expression of multiple proteins simultaneously. Positive combinations of protein expression were associated with resistance. The most significant finding was that the Stat3+NF-κB+ group developed resistance, which was significantly higher than that of the Stat3-NF-κB-group (80 vs. 14%). There was a significant difference in two-year relapse-free survival between protein-positive and protein-negative combinations of Stat3-NF-κB (P = 0.005), Bcl2-Stat3 (P = 0.009), Bcl2-Pax5 (P = 0.003), and BTK-Syk (P < 0.001). Thus, we detected key molecules in multiple signaling pathways in bone marrow aspirate smears. At the same time, the results provide further clinical evidence of ABC-DLBCL drug-resistant molecules and provide a theoretical basis for rational second-line treatment after drug resistance.

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CD5+ Diffuse Large B-Cell Lymphoma Mimicking Metastatic Carcinoma to Bone Marrow

Journal of Stem Cell Research & Therapeutics ◽

10.15406/jsrt.2017.02.00074 ◽

2017 ◽

Vol 2 (5) ◽

Author(s):

Chen Zhao

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Metastatic Carcinoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Hemophagocytic Syndrome in a Case of Splenic Large B-Cell Lymphoma

Tumori Journal ◽

10.1177/030089169608200623 ◽

1996 ◽

Vol 82 (6) ◽

pp. 621-624 ◽

Cited By ~ 2

Author(s):

Gualtiero Büchi ◽

Giuseppe Termine ◽

Renzo Orlassino ◽

Mauro Pagliarino ◽

Roberto Boero ◽

...

Keyword(s):

Bone Marrow ◽

Lymph Nodes ◽

B Cell ◽

Diagnostic Criteria ◽

Hemophagocytic Syndrome ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Peripheral Lymph ◽

Large B Cell

A case of splenic large B-cell lymphoma with hemophagocytic syndrome is reported. The difficulties of diagnosis are emphasized especially when peripheral lymph nodes or bone marrow lymphomatous infiltration are not present. Diagnostic criteria for hemophagocytic syndrome and their relationship with the pathogenesis of the disease are also stressed.

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