Diagnostic outcomes of bone marrow aspirate and trephine biopsies performed at a hospital in KwaZulu-Natal, South Africa

Background: Bone marrow aspiration and trephine biopsy (BMAT) are widely performed in adults to evaluate haematological and malignant conditions. However, the diagnostic yield from the procedure in unselected patients in the South African public sector has not previously been described. Objectives: We identified the main indications and most common diagnoses encountered for BMAT and described the demographic and blood profiles of patients, including HIV-positive patients, who had undergone the procedure at a tertiary hospital in KwaZulu-Natal.Methods: We retrospectively reviewed laboratory data from January 2016 to December 2016n for all patients aged ≥ 13 years who underwent the procedure and stratified findings by demographic data.Results: Among 120 BMAT biopsies studied, 80 (67%) cases were performed to evaluate suspected malignancy and a further 40 (33%) cases for non-malignant indications. The main indications for bone marrow examination were: cytopenias 38 (32%), lymphoma 35 (29%), leukaemia 21 (18%), and multiple myeloma 17 (14%). BMAT results revealed that 60 cases (50%) were malignant in origin, 30 cases (25%) were non-malignant and 30 cases (25%) were classified as normal. The common diagnoses were: leukaemia, 24 (20%); multiple myeloma, 16 (13%) and lymphoma, 13 (11%). Cases aged ≥ 50 years were more likely to have a malignant diagnosis (odds ratio: 5.8 (95% confidence interval: 2.2­17.1)bp-value < 0.001). Conclusion: The diagnostic yield of BMAT was high, with significant abnormalities detected in three quarters of cases. Haematological malignancy was the more common diagnosis. Increasing age was associated with an increase in reporting of haematology malignancy

Presence of Differentiating Neuroblasts in Bone Marrow is a Favorable Prognostic Factor for Bone Marrow Metastatic Neuroblastoma at Diagnosis

BACKGROUND: The prognostic impact of the presence of differentiating neuroblasts in bone marrow (BM) remains unclear in BM metastatic neuroblastoma (NB). We aimed to identify the prognostic impact of differentiating neuroblasts in BM at diagnosis and after chemotherapy. METHODS: A total of 51 patients diagnosed with BM metastatic NB at Asan Medical Center between January 1990 and July 2005 were enrolled. BM histology and laboratory data along with overall survival (OS) were compared with regard to the differentiation status of neuroblasts in BM at diagnosis and after chemotherapy. RESULTS: Among the 51 patients, 13 (25.5%) exhibited differentiating neuroblasts in BM at diagnosis and 17/51 (33.3%) exhibited them after chemotherapy. The only significant difference among patient groups was the improved OS in patients with differentiated neuroblasts in BM at diagnosis (P=0.021). In contrast, the differentiation status of neuroblasts in BM after chemotherapy did not affect OS (P=0.852). CONCLUSIONS: Our study is the first report describing the presence of differentiating neuroblasts in BM. The presence of differentiating neuroblasts in BM at diagnosis may be a favorable prognostic factor for patients with BM metastatic NB; however, the same phenomenon after chemotherapy is irrelevant to prognosis.

JAK2-positive Philadelphia-negative myeloproliferative neoplasms.

The recent discovery of the JAK2 mutations has rekindled interest in the approach to classic BCR/ABL-negative myeloproliferative neoplasms (MPNs) in terms of both diagnostic evaluation and treatment. However, additional clinical, laboratory and histological parameters play a key role to allow diagnosis and subclassification, regardless of whether JAK2 V617F mutation is present or not. Here are two cases which incidentally presented with splenomegaly and moderate leukocytosis, and were diagnosed as MPN-primary myelofibrosis (PMF) in prefibrotic phase and polycythemia vera (PV), respectively, using revised World Health Organization (WHO) 2008 criteria.

A Case of Histiocytic Sarcoma Presenting with Primary Bone Marrow Involvement

Histiocytic sarcoma (HS) is a very rare neoplasm that often shows an aggressive clinical course and systemic symptoms, such as fever, weight loss, adenopathy, hepatosplenomegaly and pancytopenia. It may present as localized or disseminated disease. We describe here a 63-yr-old male who manifested systemic symptoms, including fever, weight loss and generalized weakness. Abdominal and chest computed tomography failed to show specific findings, but there was suspicion of multiple bony changes at the lumbar spine. Fusion whole body positron emission tomography, bone scan and lumbar spine magnetic resonance imaging showed multiple bone lesions, suggesting a malignancy involving the bone marrow (BM). Several BM and bone biopsies were inconclusive for diagnosis. Necropsy showed replacement of the BM by a diffuse proliferation of neoplastic cells with markedly increased cellularity (95%). The neoplastic cells were positive for lysozyme and CD68, but negative for T- and B-cell lineage markers, and megakaryocytic, epithelial, muscular and melanocytic markers. Morphologic findings also distinguished it from other dendritic cell neoplasms.

Laboratory Evaluation of Bone Marrow Metastasis: Single Institute Study / 대한진단검사의학회지

BACKGROUND: The incidence of bone marrow (BM) metastasis might be related with the occurrence of malignant tumors in ethnic groups. So, we investigated the type and the frequency of metastatic tumors of BM and analyzed the clinicopathologic variables of BM metastasis. METHODS: This study included 932 cases of primary malignant tumor which were requested for BM study from January 1995 to June 2006 in Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Peripheral blood smears (PBS); aspirates, touch prints, and trephine biopsies of BM; and medical records including other laboratory test results were reviewed. RESULTS: Overall frequency of BM metastasis was 11.9% (111/932). Primary tumors with BM involvement in children comprised neuroblastoma (74.1%), rhabdomyosarcoma (7.4%), and malignant lymphoma (7.4%). For adult patients, they consisted of malignant lymphoma (56.0%), gastrointestinal cancer (20.2%), and lung cancer (6.0%). In the case of malignant lymphoma, diffuse large cell lymphoma was the most frequent one. Laboratory findings of patients with BM metastasis commonly showed anemia and thrombocytopenia; in addition, serum LD, ALP, AST and ALT were elevated in 81.5% (75/92), 63.4% (59/93), 63.5% (61/96) and 33.3% (32/96), respectively. Leukoerythroblastosis was observed only in 19.8% (22/111) on PBS examination. CONCLUSIONS: The most common non-hematopoietic metastatic tumor was neuroblastoma in children and gastrointestinal tumors in adults. Leukoerythroblastosis, anemia, and the elevation of serum LD, ALP, and AST were useful markers for the prediction of BM metastasis.

Recent advances in the mangement of multiple myeloma.

The management of multiple myeloma has undergone a major change during the past decade. Currently, patients < 65 years of age with advanced disease (stage II-III) are best treated with initial chemotherapy (3-4 cycles of vincristine, adriamycin and dexamethasone, or vincristine, adriamycin and methyl prednisolone, or thalidomide and dexamethasone followed by high dose chemotherapy with autologous peripheral blood stem cell transplantation. More than 50% of patients achieve complete response following this approach. The results of a number of nonrandomized and randomized studies indicate that treatment with high dose chemotherapy followed by autologous peripheral blood stem cell transplantation is associated with improved overall and event-free survival compared with conventional chemotherapy. The absence of chromosome 13 abnormalities, serum albumin levels > 3.5 g/dl and low serum b-2 microglobulin are associated with a better outcome. Almost all patients with significant bone disease or osteoporosis are candidates for therapy with bisphosphonates. About one-third of patients with relapsed or refractory myeloma benefit from therapy with thalidomide or bortezomib (a proteosome inhibitor). Recent work in the immunotherapy of myeloma suggests that some novel immune-based approaches might be useful in the management. The application of cytogenetics and molecular genetics, especially gene expression profiling, are likely to be areas of active research in future studies.

Detecção de micrometástases na medula óssea de pacientes com câncer inicial: correlação com estadiamento pós-cirúrgico(pTNM), idade e grau histológico / Detection of bone marrow micrometastases in patients with primary breast cancer: correlations with pTNM stage, age and histological grade

A disseminação oculta de células tumorais é uma das maiores causas de recaída após o tratamento local, e a detecção de células epiteliais(micrometástases) na medula óssea de pacientes com câncer de mama pode ter implicações no prognóstico. O objetivo deste trabalho foi detectar micrometástases na medula óssea utilizando técnica de biologia molecular, a imunocitoquímica(ICC), e correlacioná-la com as características clínicas e patológicas apresentadas pelas pacientes selecionadas. O aspirado de medula óssea foi obtido de 37 pacientes portadoras de câncer de mama nos estádios clínicos I, II e IIIA, com indicação de tratamento cirúrgico. A punção da medula óssea foi realizada na crista ilíaca ântero-superior, imediatamente antes do procedimento cirúrgico, e estocada em tubos tratados com heparina. Para análise da imunocitoquímica, utilizamos anticorpo monoclonal pancitoqueratina. Nossos resultados mostraram especificidade e sensibilidade para a técnica de ICC. Os casos positivos para micrometástases incluem 26,3 por cento dos pacientes sem e 72,2 por cento dos pacientes com linfonodos positivos. Concluímos que a presença de micrometástases na medula óssea foi estatisticamente significativa quanto ao grau histológico do tumor e quanto ao número de linfonodos axilares comprometidos. Nas pacientes com axilas livres, consideradas de baixo risco, a presença de micrometástases na medula óssea permite identificar um subgrupo de pacientes de risco

Bone marrow involvement by metastatic solid tumors.

A five year experience with bone marrow aspirates and biopsies positive for metastatic carcinoma is reviewed. Marrow examination in 25 cases detected metastasis. The common primary tumors with marrow metastasis were neuroblastoma, carcinoma breast and prostate. In 56% cases primary site could not be ascertained from bone marrow as metastatic tumor showed undifferentiated morphology. The study demonstrates the usefulness of combining trephine biopsy with aspirate examination for increased detection of bone marrow metastasis.

Significado clínico de la punción seca de médula ósea o "Dry tap" / Clinical significance of dry tap bone marrow aspiration

Determinar la frecuencia de "aspirado seco" de la enfermedad de fondo y las características clínicas asociadas. Materiales y métodos: Se revisaron 1358 informes de aspirado de médula ósea realizados en el Hospital Nacional Cayetano Hereida entre 1º de enero de 1990 y 31 de marzo de 1996. Resultados: Entre los 1358 informes de aspirado de médula ósea se encontraron 39 aspirados secos lo que constituye una frecuencia de 2.9 por ciento. Las patologías más frecuentes asociadas a aspirado seco de médula ósea fueron las mieloptisis neoplásicas con 52.9 por ciento de los casos y de ellas las leucemias con 35.3 por ciento. Otros diagnósticos fueron síndrome de inmunodeficiencia adquirida con 11.8 por ciento y aplasia medular con 11.8 por ciento. En el 14.7 por ciento de los aspirados secos las biopsias no mostraron patología medular significativa. Conclusiones: El 2.9 por ciento de las punciones de médula ósea son aspirados secos. la causa más frecuente de aspirado seco fueron las leucemias. El hallazgo de normoblastos y/o trombocitopenia en sangre periférica no ha servido para predecir la existencia de patología medular en los casos de aspirado seco.