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Published on: March 25, 2016
[Value of "non-specific" lymphoid infiltrates in bone marrow in high grade malignant peripheral non-Hodgkin's
1Pathologisches Institut, Universität Freiburg.
Insights
Abnormal lymphoid infiltrates (ALI) in bone marrow are linked to extramedullary high-grade lymphomas (NHL). These infiltrates may represent premalignant cells or low-grade NHLs that evolve into high-grade disease.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Extramedullary high-grade Non-Hodgkin's lymphomas (NHL) can present without bone marrow involvement.
- The presence and nature of bone marrow infiltrates in these cases require further investigation.
Purpose of the Study:
- To investigate the characteristics of bone marrow infiltrates in patients with extramedullary high-grade NHL.
- To determine if these infiltrates represent a precursor or related entity to the high-grade lymphoma.
Main Methods:
- Analysis of iliac crest bone marrow biopsies from 120 patients with extramedullary high-grade NHL.
- Cytological examination of bone marrow lymphoid infiltrates.
- Immunohistochemical analysis (CD3+, CD20+) of selected infiltrates.
- Comparison with the primary extramedullary NHL.
Main Results:
- Abnormal lymphoid infiltrates (ALI) were found in the bone marrow of 69 out of 120 patients.
- Immunohistochemistry revealed ALIs composed of CD3+ cells, sometimes with CD20+ cells.
- In 10 cases, ALIs met the criteria for low-grade NHL.
- Low-grade NHL residues were found near the high-grade lymphoma in 7 out of 10 cases.
Conclusions:
- Bone marrow ALIs associated with extramedullary high-grade NHL can represent clonal expansion of premalignant lymphoid cells.
- These ALIs may also represent low-grade NHLs that can evolve into high-grade extramedullary disease.
- The findings suggest a potential pathway for the development of high-grade NHL from precursor lesions in the bone marrow.
Abstract:
We studied iliac crest biopsies of 120 patients with extramedullary high-grade Non-Hodgkin's lymphomas (NHL). The bone marrow of 69 patients contained foci of small lymphoid cells, which cytologically differed significantly from the extramedullary NHL and which we termed abnormal lymphoid infiltrates (ALI). The ALIs in 14 out of 25 cases immunohistochemically investigated in more detail were made up of small CD3+ cells optionally intermingled with a minority of CD20+ cells of small to intermediate size. In 10 patients, however, the ALIs satisfied the criteria of a low-grade NHL. In the vicinity of the extramedullary high-grade lymphoma, residues of the corresponding low-grade NHL were identified in up to 7 of 10 cases. We conclude that bone marrow ALIs associated with extramedullary high-grade NHL exhibit at least in part the criteria of a systemic clonal expansion of premalignant lymphoid cells or low-grade NHLs respectively, which gives rise to the final evolution of the extramedullary high-grade NHL.
