Bone marrow involvement by non-hodgkin's lymphoma: clinicopathologic and immunophenotypic factors contributing to proper staging and grading

ABSTRACT

Diagnostic results from bone marrow [BM] aspirate examination, immunophenotyping and BM biopsy of 50 patients with non-Hodgkin's lymphoma were interpreted. Five cases with BM involvement by trephine biopsy were missed by inimunophenotyping. In turn, three cases negative by trephine biopsy, were found to be positive by immunophenotyping Immunophenotyping increased the number of true positive detected BM-infiltrations by trephine biopsy from 48% to 54%. Consequently, after these extensive methods of BM investigations I9 patients with initial stage I, II or III become restaged in stage IV Lymph node [LN] and BM biopsies of the involved patients were compared. Discrepancy in the histopathologic subtypes [which determine the grade of the tumor] in LN and BM was found in 8 cases. The most notable in this group were two cases who had small lymphocytic lymphoma [low grade] in the LN biopsy but the BM biopsy revealed large cell lymphoma [intermediate grade] in one case and lymphoblastic lymphoma [high grade] in the other case. In overall, the differences in the tumor stage and grade, after BM investigations, had led to different therapeutic strategies. We conclude from our data that immunophenotyping and grading of NHL according to the BM finding is feasible and clinically relevant for proper treatment