Immunohistochemistry in bone marrow pathology: a useful adjunct for morphologic diagnosis

Area of Science:

• Hematopathology
• Oncology
• Immunohistochemistry

Background:

• Bone marrow (BM) trephine biopsies are standard for diagnosing hematologic neoplasms.
• Conventional morphology is the gold standard, but immunohistochemistry is increasingly integral.
• Newer WHO classifications provide a framework for accurate diagnosis.

Purpose of the Study:

• To review the current state of bone marrow immunohistochemistry for diagnosing hematologic disorders.
• To propose diagnostic algorithms and antibody panels for a rational approach.
• To highlight the role of immunohistochemistry in classifying hematologic neoplasms.

Main Methods:

• Review of current literature and diagnostic practices in bone marrow immunohistochemistry.
• Discussion of antibody applicability and necessary protocol modifications for BM trephines.
• Presentation of diagnostic algorithms and antibody panels.

Main Results:

• Immunohistochemistry is essential for confirming lymphoma, subclassifying leukemias, and estimating blast counts.
• It aids in characterizing BM involvement by nonhematologic neoplasms.
• Small B-cell lymphomas and other entities involving the BM are readily classified using immunohistochemistry.

Conclusions:

• Immunohistochemistry significantly improves the accuracy and efficiency of diagnosing hematologic disorders in bone marrow biopsies.
• Standardized protocols and rational antibody panels are key for cost-effective diagnostics.
• This approach supports accurate staging and classification, aligning with current WHO guidelines.