Value of bone marrow biopsy in the diagnosis of amyloidosis

Amyloid involvement of the bone marrow is not commonly diagnosed before necropsy. Paraffin sections of the trephine bone biopsy specimen are superior to marrow aspiration cell smears for the antemortem diagnosis. Thirteen cases of amyloidosis were diagnosed from the bone biopsy specimen during a ten-year period. Amyloid was detected in only two of the corresponding aspirates. Three morphologic patterns of marrow involvement were found: vascular, focal extravascular/perivascular, and diffuse. Five (38%) of the cases were associated with multiple myeloma. An abnormal immunoglobulin was detected in the serum or urine or both in ten of 11 cases when determined. Although the bone marrow may not be the best site for the diagnosis of amyloidosis, it should not be neglected and marrow biopsies taken for other diagnostic reasons may "incidentally" reveal amyloid. Amyloidosis should be included in the list of non-primary hematologic conditions of the bone marrow in which the trephine biopsy may prove useful for diagnosis.