Immunohistochemistry in Staging Bone Marrow Biopsy Specimens: a Useful Adjunct for Morphological Diagnosis in Non Hodgkin’s Lymphoma

Abstract Background: Morphological examination of bone marrow trephine biopsy represents a standard method for non-Hodgkin’s lymphomas (NHL) staging. Immunohistochemistry staining of bone marrow trephine specimens has been widely used in haematological malignancies due to its high applicability and sensitivity at diagnosis. However, the routine use of immunohistochemistry in the clinical settings when there is no obvious morphological (light microscopic) evidence of lymphoma in the bone marrow trephine, is not yet well established universally. We assessed the value of immunohistochemistry (by using a standard basic panel of anti-CD20 and anti-CD3 staining) in detecting involvement by NHL in routinely processed bone marrow trephine specimens with no obvious morphological involvement with lymphoma. Methods: This study involved 56 randomly selected paraffin wax embedded, formalin fixed bone marrow trephine specimens between February 2011 and September 2013 from three teaching hospitals in Northeast, UK. 49 patients (87%) had B-cell NHL: diffuse large B cell lymphoma (DLBCL) 43% (n=24), follicular lymphoma (FL) 18% (n=10), marginal zone lymphoma (MZL) 9% (n=5), mantle cell lymphoma (MCL) 7% (n=4), lymphoplasmacytic lymphoma (LPL) 6% (n=3) and Burkitt’s lymphoma (BL) 6% (n=3). 7 cases (12%) had T/NK lymphomas. There was no obvious morphological evidence of bone marrow infiltration as all samples were reviewed by two examiners. All specimens were stained with the anti-CD20 and anti-CD3 antibodies. Results: Concordant results were found in 50 samples (89%), as both investigations were reported negative. 6 of the 56 cases (11%) with no morphological evidence of involvement by NHL on routine stains, were positive on immunohistochemistry. Considering histology, discrepant results were noted more frequently in T/NK lymphomas (42%; 3 of 7 cases) comparing to B-cell NHLs (6%; 2 cases of DLBCL and 1 case of FL). In all six cases the lymphoid infiltrates had diffuse pattern. Conclusions: Our results indicate that immunohistochemistry can detect a subgroup of NHL patients with bone marrow involvement beyond discriminatory level of conventional stains (Haematoxylin & Eosin and Giemsa), thereby contributing to accuracy of staging and treatment planning. Rational application of immunohistochemistry is a cost-effective & valuable method in routine investigation of staging bone marrow trephine biopsies. Disclosures No relevant conflicts of interest to declare.

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BONE MARROW INFILTRATION ASSESSMENT BY FDG 18 ‐PET: CAN THIS IMAGING TEST REPLACE BONE MARROW TREPHINE BIOPSY IN DIFFUSE LARGE B CELL LYMPHOMA STAGING?

Hematological Oncology ◽

10.1002/hon.84_2880 ◽

2021 ◽

Vol 39 (S2) ◽

Author(s):

S. Duarte ◽

C. Afonso ◽

B. Marques ◽

C. Barros Lima ◽

D. Neves ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Bone Marrow Infiltration ◽

Trephine Biopsy ◽

Bone Marrow Trephine ◽

Bone Marrow Trephine Biopsy ◽

Large B Cell Lymphoma ◽

Large B Cell

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Follicular large-cell lymphoma treated with intensive chemotherapy: an analysis of 89 cases included in the LNH87 trial and comparison with the outcome of diffuse large B-cell lymphoma. Groupe d'Etude des Lymphomes de l'Adulte.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1654 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1654-1663 ◽

Cited By ~ 48

Author(s):

D Wendum ◽

C Sebban ◽

P Gaulard ◽

B Coiffier ◽

H Tilly ◽

...

Keyword(s):

Bone Marrow ◽

Prognostic Factors ◽

B Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

Large Cell ◽

Intensive Chemotherapy ◽

Large B Cell Lymphoma ◽

Beta 2 Microglobulin

PURPOSE The aims of this study were as follows: (1) to analyze clinical, histopathologic characteristics, treatment outcome, and prognostic factors of patients with follicular large-cell lymphoma (FLCL); and (2) to compare them with those of patients with diffuse large B-cell lymphoma (DLCL) treated in the same therapeutic trial. PATIENTS AND METHODS Eighty-nine FLCL patients who were histologically reviewed and who received an intensive chemotherapy regimen according to the LNH 87 protocol were analyzed and compared with 1,096 B-cell DLCL patients included in the same protocol. RESULTS After intensive induction treatment, 59 patients (67%) achieved a complete remission [CR]. Estimated 5-year survival was 59%, and estimated 5-year freedom from progression (FFP) was 39%. Prognostic factors associated with shorter FFP were age greater than 60 years (P = .02), advanced clinical stage (P = .01), abnormal lactic dehydrogenase (LDH) level (P = .02), abnormal beta-2 microglobulin (P = .02), B symptoms (P = .03), bone marrow involvement (P = .04), and high expression of bcl-2 protein (P = .05). When compared with B-cell DLCL patients, FLCL patients were younger (P = .02), had a better Eastern Cooperative Oncology Group (ECOG) status (P = .05), less bulky mass (P = .04), more advanced clinical stages (P < .001), and more bone marrow involvement (P = .02). No significant difference was observed between FLCL and DLCL patients for response to therapy (67% v 67% of CR), 5-year overall survival (58% v 51%), 5-year disease-free survival (53% v 57%), or FFP survival (39% v 43%). CONCLUSION FLCL patients have a favorable response rate and survival when treated with intensive chemotherapy. Their outcome is similar to that of B-cell DLCL patients, and a long-term FFP is observed for a substantial number of patients. Some adverse prognostic factors (including those of the International Prognostic Index, bone marrow involvement, and beta-2 microglobulin) have been identified to define a subset of patients who require other therapeutic approach.

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Occult bone marrow involvement in patients with diffuse large B-cell lymphoma: results of a pilot study

Pathology ◽

10.1080/00313020701684417 ◽

2007 ◽

Vol 39 (6) ◽

pp. 580-585 ◽

Cited By ~ 14

Author(s):

Dipti Talaulikar ◽

Jane E. Dahlstrom ◽

Bruce Shadbolt ◽

Michelle McNiven ◽

Amy Broomfield ◽

...

Keyword(s):

Bone Marrow ◽

Pilot Study ◽

B Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Skeletal Muscle Lymphoma Presenting with Chronic Compartment Syndrome of Leg after Trauma

Case Reports in Oncological Medicine ◽

10.1155/2018/4078672 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jhong-You Li ◽

Chung-Liang Li ◽

Chun-Kuan Lu

Keyword(s):

Skeletal Muscle ◽

Bone Marrow ◽

B Cell ◽

Compartment Syndrome ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

Tumor Lysis Syndrome ◽

B Cell Lymphoma ◽

Medical Attention ◽

Chronic Compartment Syndrome

Compartment syndrome may be acute or chronic based on the clinical course and etiology. Here, we report the first known case to be diagnosed with skeletal muscle-derived B-cell lymphoma presenting with chronic compartment syndrome after trauma. A 62-year-old woman sought medical attention due to a one-month history of painful left lower leg swelling and paresthesia of the medial side of the foot after falling over. The patient underwent fasciotomy and debridement under the preoperative diagnosis of fasciitis and myositis with associated compressive neuropathy. Preoperative laboratory tests were within normal limits. Postoperative pathologic examination and bone marrow aspiration revealed B-cell lymphoma with bone marrow involvement postoperatively. Tumor lysis syndrome took place, presenting with drowsiness, poor appetite, and oliguria, after the operation along with multiple organ failure. Awareness of the differential diagnoses of compartment syndrome in such clinical situation is crucial because it may lead to different examination and treatment plan preoperatively.

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Cytomorphology and Molecular Characterization of CLTC-ALK Rearrangement in 2 Cases of ALK-Positive Diffuse Large B-cell Lymphoma with Extensive Bone Marrow Involvement

Annals of Laboratory Medicine ◽

10.3343/kjlm.2008.28.2.89 ◽

2008 ◽

Vol 28 (2) ◽

pp. 89-94 ◽

Cited By ~ 5

Author(s):

Hee-Suk Choung ◽

Hee-Jin Kim ◽

Won-Seog Kim ◽

Kihyun Kim ◽

Sun-Hee Kim

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

Alk Rearrangement ◽

Large B Cell Lymphoma ◽

Alk Positive ◽

Large B Cell

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High-Grade Diffuse Large B-Cell Lymphoma in Elderly Patients: Russian Multicenter Trial Results in R-EPOCH/R-HMA Protocol

Blood ◽

10.1182/blood.v128.22.5386.5386 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5386-5386

Author(s):

Olga A. Gavrilina ◽

Eugene E. Zvonkov ◽

Elena N. Parovichnikova ◽

Nelly G. Gabeeva ◽

Vera V. Troitskaya ◽

...

Keyword(s):

Bone Marrow ◽

Elderly Patients ◽

B Cell ◽

Older Patients ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

High Grade ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background: The number of elderly patients with diffuse large B-cell lymphoma (DLBCL) in our aging society continues to rise. Median of age for patients with diffuse large B-cell lymphoma (DLBCL) is 60. Approximately 50% of older patients with DLBCL are defined as high-grade by IPI and these forms are characterized by aggressive course and poor response to standard chemotherapy (CT). Intensive protocols cannot be performed due to their toxicity for older patients with comorbidity. Addition of R-HMA to R-DA-EPOCH favourably changes the outcome in patients with untreated high-grade diffuse large B-cell lymphoma and didn't have higher toxicity [ASH 2015 # 2708]. Aim: To evaluate the efficacy and toxicity of R-EPOCH/R-HMA protocol in older patients with untreated high-grade diffuse large B-cell lymphoma. Patients and Methods: 19 untreated older DLBCL patients from 4 centers were enrolled in a prospective study between August 2013 - July 2016; stage II-IV; ECOG 0-3; median age 66 years (60-78); age ≥70y/60<70y 21%/79%; M/F 52%/48%; IPI: 52% high-intermediate and 48% high risk; 26% with bone marrow involvement. Severe comorbidity was diagnosed in 8 (42%) patients (coronary heart disease, hypertonic disease, chronic obstructive pulmonary disease and arrhythmia). All patients underwent 4-6 courses (2-3 cycles) of chemotherapy: R-EPOCH (standard dose and scheme), R-HMA (R 375 mg/m2 d1, MTX 500 mg/m2 24 hours d 2, AraC 1000 mg/m2 q 12 hrs d 3-4). In 3 cases of DLBCL with bone marrow involvement BEAM conditioning and autologous stem cell transplantation were applied. Results: The median follow-up is 18 months (3-37). There was no mortality associated with toxicity. The main non-hematological toxicities of R-HMA were infections (mucositis, pneumonia, sepsis, enteropathy) grades 1-2 and 3-4 in 90% and 10%, respectively. Hematological toxicity grade 4 for less than 4 days we observed only after courses R-HMA. Complete remission (CR) was achieved in 18 (100%) patients and 1 patient in the treatment now. There are four failures in patients older than 60 years: three relapses (after 6 and two after 14 month CR) and one death after 7 month CR by reasons not related with DLBCL. With a median follow 18 months overall and event-free survival of 19 older patients constituted 93,8% and 75,9%, respectively (Fig.1). There is no difference in older patients according to stage, IPI, LDH level, ECOG status for OS and EFS. So the combination of R-EPOCH/R-HMA may be considered as optimal intensive approach in older patients. Conclusions: TheR-EPOCH/R-HMA protocol demonstrated acceptable toxicity and high efficacy in older patients with high-grade DLBCL. Figure 1 Overall (A) and Event-free (B) survival in elderly patients with DLBCL. Figure 1. Overall (A) and Event-free (B) survival in elderly patients with DLBCL. Disclosures No relevant conflicts of interest to declare.

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