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Bone marrow involvement in T-cell-rich B-cell lymphoma
B F Skinnider1, J M Connors, R D Gascoyne
1Department of Pathology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada.
American Journal of Clinical Pathology
|November 14, 1997
Summary
Bone marrow involvement is common in T-cell-rich B-cell lymphoma (TCRBCL), often appearing paratrabecular. Immunohistochemistry aids diagnosis, distinguishing TCRBCL from similar conditions like Hodgkin's disease.
Area of Science:
- Hematopathology
- Oncology
- Immunohistochemistry
Background:
- T-cell-rich B-cell lymphoma (TCRBCL) diagnosis can be challenging.
- Bone marrow (BM) staging is crucial for lymphoma management.
- Histologic overlap exists between TCRBCL, Hodgkin's disease, and T-cell lymphomas.
Purpose of the Study:
- To characterize the histologic and immunohistochemical findings of BM involvement in TCRBCL.
- To evaluate the diagnostic utility of immunohistochemistry in TCRBCL BM staging.
- To compare BM involvement patterns in TCRBCL with other lymphomas.
Main Methods:
- Retrospective analysis of 13 BM biopsy specimens from patients with diagnosed TCRBCL.
- Histologic examination of BM infiltrates.
- Immunohistochemical staining for CD20, CD15, and CD30.
Main Results:
- Bone marrow involvement detected in 8 (62%) of 13 cases, predominantly paratrabecular.
- Histology mimicked Hodgkin's disease due to polymorphous infiltrates and pale appearance.
- Immunohistochemistry confirmed CD20+ large atypical cells, with CD15- and CD30-negative results, supporting TCRBCL diagnosis.
- A significant T-cell infiltrate accompanied atypical B-cells in positive BM specimens.
Conclusions:
- Bone marrow biopsy is valuable for staging TCRBCL, revealing frequent involvement.
- Immunohistochemistry is essential for differentiating TCRBCL from Hodgkin's disease and other lymphomas.
- The high rate of BM involvement suggests TCRBCL may be biologically distinct from diffuse large B-cell lymphoma.