Immunohistologic studies of bone marrow biopsies on frozen sections: an analysis of 42 cases

An immunohistologic study of bone marrow biopsy frozen sections from 42 cases involved by a variety of reactive and neoplastic disorders is presented. Thirteen cases also were studied using other methods, including cytochemistry, surface marker analysis of cell suspensions, and/or DNA hybridization. Thirty-four of 42 cases (81%) were adequately phenotyped on frozen tissue using a panel of antibodies for hematolymphoid-associated antigens. The immunostains from the remaining eight cases were unsatisfactory, primarily as a result of heavy background staining. Eighteen cases were lymphoproliferative disorders of B-cell phenotype and 12 of these showed surface monotypic immunoglobulin expression by the frozen section technique. Six cases showed B- or pre-B-cell antigens but no surface immunoglobulins. Of the remaining 16 patients, two cases showed myeloid markers and three showed T-cell phenotype. Nine cases showed a mixture of polyclonal B- and T-cell populations. Keratin was demonstrated in a single case of metastatic carcinoma included in the study. These results indicate that the majority of hematopoietic processes can be successfully phenotyped on bone core frozen sections and demonstrate the usefulness of immunohistologic study of the frozen bone marrow biopsy specimens, especially when the specimens for other modalities are not available or are inadequate. The keys to achieving the best results from the frozen bone marrow immunohistochemistry were the gentle handling of the specimens and the preparation of high-quality, cryostat-cut frozen sections.