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Updated: Jul 9, 2026
Characterization of Leukocyte-platelet Rich Fibrin, A Novel Biomaterial
Published on: September 29, 2015
[Bone marrow fibrin-ring granuloma: review of 24 cases]
Hee-Jung Chung1, Hyun-sook Chi, Young-Uk Cho
1Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Background:
Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma.
Methods:
We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group.
Results:
The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05).
Conclusions:
Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.
Insights
Fibrin-ring granuloma (FRG) in bone marrow is often caused by Epstein-Barr Virus (EBV) infection, which is linked to a poorer prognosis. Prompt diagnosis and treatment are crucial for patients presenting with fever.
Area of Science:
- Hematology: Investigating bone marrow pathology and its systemic implications.
- Infectious Diseases: Understanding the role of viral infections in granuloma formation.
- Oncology: Examining the association of granulomas with hematologic malignancies and chemotherapy.
Background:
- Fibrin-ring granuloma (FRG) is a distinct epithelioid granuloma subtype found in bone marrow and liver.
- FRG is associated with diverse etiologies including infections (e.g., Epstein-Barr Virus), drug reactions, and lymphomas.
Observation:
- A retrospective review of 24 bone marrow biopsy patients diagnosed with FRG between 1995 and 2004.
- Clinical symptoms and laboratory findings were analyzed to classify patients by etiology and compare prognoses.
Findings:
- Epstein-Barr Virus (EBV) infection was the most common cause of FRG, identified in 41.4% of patients.
- Leukemia/lymphoma post-chemotherapy (33.3%) and fever of unknown origin (20.8%) were other significant causes.
- Fever and cytopenia were the most frequent clinical presentations; EBV-associated FRG correlated with lower survival rates (P<0.05).
Implications:
- Bone marrow FRG, especially when accompanied by fever, necessitates thorough investigation for infectious agents like EBV.
- Early identification of EBV as the underlying cause is critical due to the associated poor prognosis.
- This study highlights the importance of considering specific etiologies, particularly EBV, in the differential diagnosis of bone marrow FRG.
