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Background. Classical Hodgkin’s lymphoma is a B-cell lymphoproliferative disease, the tumor substrate of which is Berezovsky–Reed–Sternberg cells, characterized by CD30, PAX-5, CD15 expression and the absence of CD3, CD45. In some cases, tumor cells express CD20. modern anticancer therapy has increased the survival probability for most patients, not only with early but also with advanced stages of classical Hodgkin’s lymphoma. Such successes are mainly due to the distribution of patients into prognostic groups and the choice of an appropriate treatment regimen. tumor infiltration of the bone marrow suggests assigning patients to the advanced stages group, followed by the choice of an intensive therapy program. Aim. To determine the bone marrow involvement frequency according to positron emission tomography combined with computed tomography (PET/CT), with 18F-fluorodeoxyglucose (FDG) and bone marrow trephine biopsy (bmtb), to compare the results obtained with primary tumor immunophenotype and bone marrow cellular composition, and to identify of prognostic risk factors. Materials and methods. The study included 107 patients with newly diagnosed classical Hodgkin’s lymphoma, who underwent a diagnostic examination at the moscow research institute of oncology named after P. A. Herzen – a branch of the National Medical Research Center for Radiology and the “Lapino” clinical Hospital from 2015 to 2022, followed by anticancer therapy and further follow-up. Morphology of the primary tumor biopsy specimen in all patients and immunohistochemical (IHC) study using a wide panel of monoclonal antibodies (CD15, CD30, CD3, CD45, CD20, PAX-5 anti-gens; in some cases epstein–barr virus proteins expression) in most cases were performed. All patients underwent a morphological and / or IHC study of BMTB and the majority underwent aspiration biopsy and PET/CT with 18F-FDG. Results. The most common histological variant of classical Hodgkin’s lymphoma was nodular sclerosis (86.9 %). The majority of patients (51.4 %) were assigned to the advanced stage prognostic group. bone marrow tumor infiltration was statistically significantly more frequently diagnosed during PET/CT with 18F-FDG compared with the results of the BMTB – in 27.1 % and 12.1 % of cases, respectively (p < 0.05). when comparing the results of both diagnostic methods, it was found that in 17.1 % of cases, bone marrow infiltration, detected during PET/CT, was not confirmed by IHC examination of the trephine biopsy. In addition, it was found that the majority of cases with CD20+/± and CD15+/± expression in the primary tumor were observed in the group of patients without bone marrow involvement. when assessing the cellular composition of bone marrow aspirates, it was revealed that in patients with bone marrow tumor infiltration, an increase in cellularity and megakaryocytes number along with a decrease in the plasma cells number is observed. Conclusion. The results suggest further study of bone marrow immunomorphological features in order to identify prognostic factors and search for new therapeutic targets. a more extended analysis of bone marrow aspirate immunomor-phological characteristics using new modern diagnostic methods, minimal residual disease status as a surrogate marker seems to be relevant and necessary to confirm the depth of the antitumor response achieved. Detection of CD20+/±- and cd15+/±-Berezovsky–Reed–Sternberg cells according to primary tumor IHC analysis indicates a low probability of bone marrow tumor infiltration, but further analysis is required on a large clinical and laboratory material.

Bone marrow biopsy depends on tissue morphology, immunohistochemical staining, and moleculardetection. Tissue pretreatment is required for bone marrow samples, from clinical specimen acquisition to pathological reporting, but during the process, proteins and nucleic acids are often altered because of the acid in fixation and decalcification solutions. In our study, we present an easy and effective pretreatment protocol and compared this novel pretreatment protocol (Set 2) with an existing traditional pretreatment process (Set 1) using tissue morphology, IHC staining, and molecular pathological analyses. Granulocytic IHC markers showed more intensive staining in samples of Set 2 than in those of Set 1. The Set 2 protocol provided a higher DNA yield and less fragmentation; moreover, samples processed with the Set 2 protocol could be subsequently used in FISH and DNA sequencing assays. Our optimized novel pretreatment protocol could better protect proteins and DNA molecules while maintaining good cell morphology compared to traditional pretreatment The novel pretreatment reagents could role as a reference by more laboratories for pretreating bone marrow biopsy samples and scientific research. [ABSTRACT FROM AUTHOR]

Background: Bone marrow (BM) in addition to being the origin of primary hematological malignancies is also commonly involved in metastatic solid tumors. Bone marrow examination includes aspiration and biopsy, and it is a well-known procedure not only to diagnose hematological malignancies but also for staging and prognosis of various solid tumors. The presence of metastasis in the bone marrow is of grave prognostic significance and it is imperative to rule out marrow involvement in any malignancy where curative treatment is considered. The study's objectives were to evaluate the clinical, hematological, and biochemical characteristics of patients with BM metastases of solid tumors diagnosed by bone marrow (BM) aspiration and trephine biopsy and to find out the accuracy rate of diagnosing metastatic infiltration between bone marrow aspiration, trephine imprints, and trephine biopsy procedures., Methodology: It was a 4.5-year retrospective hospital-based observational study where relevant clinical, biochemical, and hematological parameters including bone marrow aspirate and biopsy were analyzed and compiled from hospital medical records., Results: The total number of BMA and trephine biopsies that came during the duration of 4.5 years were 3850 and 2980 respectively. Out of the 3850-bone marrow aspiration and 2980 trephine biopsies received in the dept of Hematology, 305 cases were referred to look for metastatic bone marrow infiltration. Out of these 305 cases, 69 cases showed the presence of metastatic deposits (12.6%). 45 patients (65.2%) were males, and 24 patients (34.7%) were females with M:F ratio of 1.8:1. Most common age group was 51-60 years (31.8%). The most common complaints were fever, body aches, weight loss, and weakness. Clinical examination revealed pallor in 38 out of 69 cases (55%) and organomegaly in 14 cases (20.2%). Microcytic hypochromic anemia (26%) was the most common finding on peripheral blood smear examination followed by pancytopenia (18.8%). The biochemical findings most commonly observed were raised LDH (60.8%), serum PSA (36.3%), and alkaline phosphatase (21.7%)., Conclusion: Trephine biopsy is a sensitive method for detecting marrow metastasis and should be done in all cases being investigated for this purpose. BMA alone may miss marrow metastases in almost half of cases. Trephine imprint cytology is more sensitive than BMA and can provide rapid diagnoses while waiting for trephine biopsy results., Competing Interests: none, (Copyright © 2024 Nigerian Medical Association.)

The 2008 ICSH guideline was proposed to bring uniformity in bone marrow reporting among pathologists worldwide. The objective was to study the usefulness of on-site procedural information in routine marrow reporting. The nature of marrow aspirate, gross appearance, and core length of iliac crest trephine biopsies from 174 consecutive subjects (109 males, 65 females, mean age 47.5 ± 19.2 years) were reviewed by a pathologist blinded to the final diagnosis. The nature of aspirate had a significant correlation with a positive diagnostic yield among 149/176 (84.6%) cases (P = 0.03). Among cytopenic subjects, megaloblastic anemias (MA) (N = 27) and aplastic anemias (AA) (N = 14) had richly particulate and greasy/fat rich aspirates, respectively (P < 0.001). Eighty-six of 104 (82.7%) normal vs. 61/70 (87.1%) abnormal cores (for age) yielded a diagnosis (P = 0.43). Seventeen (63%) of the MA had a deep red trephine core (P = 0.18); and 12/14 (84.5%) of the AA had yellowish trephine core (P = 0.008). Though acute leukemias (N = 38) yielded variable aspirate materials (P = 0.34), they were more likely to have a pale, discolored trephine core (30/38 (79%) vs. 8/38 (21%), P < 0.001). A core length of ≥ 15 mm (N = 155) had higher diagnostic yield compared to < 15 mm (N = 19) (P = 0.05). Careful documentation of on-site marrow procedure information is necessary; and this may provide valuable clues for the morphological diagnosis. [ABSTRACT FROM AUTHOR]

Recently, deep learning frameworks have been shown to be successful and efficient in processing digital histology images for various detection and classification tasks. Among these tasks, cell detection and classification are key steps in many computer-assisted diagnosis systems. Traditionally, cell detection and classification is performed as a sequence of two consecutive steps by using two separate deep learning networks: one for detection and the other for classification. This strategy inevitably increases the computational complexity of the training stage. In this paper, we propose a synchronized deep autoencoder network for simultaneous detection and classification of cells in bone marrow histology images. The proposed network uses a single architecture to detect the positions of cells and classify the detected cells, in parallel. It uses a curve-support Gaussian model to compute probability maps that allow detecting irregularly shape cells precisely. Moreover, the network includes a novel neighborhood selection mechanism to boost the classification accuracy. We show that the performance of the proposed network is superior than traditional deep learning detection methods and very competitive compared to traditional deep learning classification networks. Runtime comparison also shows that our network requires less time to be trained. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to evaluate the role of histopathological examination of paraffin embedded marrow clot sections in the diagnosis of different neoplastic and non-neoplastic marrow diseases, and whether these sections can replace the need for performing bone marrow trephine biopsy. Methods: Patients included in the study are those with clinical manifestations of hematological disorders who were subjected to peripheral blood examination, marrow aspirate cytology with complimentary bone marrow trephine and marrow clot biopsy. Along with marrow aspiration, the blood left behind after preparing marrow smears, was used to prepare paraffin embedded histological clot sections. The results for 114 patients were analyzed simultaneously for their concordance to highlight the usefulness of marrow clot sections in the diagnosis of different diseases affecting the bone marrow. Immunohistochemical stains were used whenever indicated to obtain additional diagnostic information. Results: Marrow clot sections were diagnostic and concordant with the complete blood count, marrow aspirates and trephines in 63% of the cases. While trephines were unconvincing in another 15.7% of the cases, the clot sections were diagnostic. In 1.7% of the cases, the clot sections and trephines were diagnostic while marrow aspirates were inconclusive, thus in 81% of the cases, marrow clot sections provided the diagnosis and replacing the need for performing trephine biopsy. However, trephine biopsy is still considered necessary in 19 % of the cases in whom the clot sections are of poor quality and unconvincing Conclusion: In most of the cases clot sections can replace the need for trephine biopsy, but trephine biopsy is still required in other cases. The clot sections are useful as an adjuvant procedure to increase the diagnostic yield in marrow studies. Because it is difficult to expect which patients will be diagnosed by clot sections and which will need trephine biopsy, it is advisable to perform both trephine and clot biopsy together with the marrow aspirates.

Introduction Bone marrow aspiration (BMA) and bone marrow biopsy (BMB) is an indispensable diagnostic tool for evaluating haematological and non-haematological disorders and patient follow-up in present era. We have compared the advantages of trephine biopsy over bone marrow aspiration in these patients. Aim and objective To evaluate sensitivity and specificity of trephine biopsy test for haematological and non haematological disorder patients in comparison to bone marrow aspiration test. Materials and method In this 1 year prospective study (June 2014–May 2015), we evaluated the haematological and non-haematological disorder patients by BMA and BMB (aided with I.H.C. when ever needed). The sensitivity and specificity of the tests were calculated. Results Among, final 504 hemotological/non haematological disorder patients, 416 cases were diagnosed (+ve) in BMA test, where as it was 494 in BMB test and with chi 2 test it was highly significant as p = 0.0001. It was concluded that True positive cases were 416, True negative were 9 cases, false negative 78 cases and false positive was in one case only. The sensitivity and specificity of bone marrow trephine biopsy test was 84% and 90% respectively. Conclusion BMB (aided with I.H.C) is a gold standard test for detecting different haematological and non hamatological disorders. In our study the sensitivity and specificity of BMB test was 84% and 90% respectively. When performed in association with BMA in the same sitting, significantly augments the chances of reaching a correct diagnosis. [ABSTRACT FROM AUTHOR]

We evaluated the impact of bone marrow sample characteristics on the detection of persistent cytogenetic abnormalities (PCA) following induction chemotherapy for acute myeloid leukemia (AML). PCA’s were identified in 20.4% of patients and were more common with complete remission without count recovery (CRi) vs. those with count recovery (CR, 45.8 vs. 13.5%,p = .001), with  >2% blasts vs.  ≤2% blasts (42 vs. 12%,p =  .001) and with hypocellular trephine biopsies relative to those with normo/hypercellular biopsies (42.1 vs. 17.3%,p  = .03), although in a multivariate analysis only CRi and blast count >2% were independently associated with a PCA. PCA’s were not observed in patients with favorable risk karyotype. Amongst patients with intermediate and unfavorable risk karyotypes PCA were not associated with differences in overall or, amongst non-transplanted patients, relapse free survival. Thus, although PCAs are common post-induction it is unclear whether they provide any independent prognostic information beyond the diagnostic karyotype. [ABSTRACT FROM AUTHOR]

Bone marrow aspiration and trephine biopsies are commonly used procedures in clinical practice. The practice of making a clot section by using the leftover blood from the bone marrow aspirate material is not a commonly followed practice across centers. A clot section has the advantage of studying the added material with an increased possibility of detecting focal lesions such as myeloma, lymphoma, granuloma, and metastasis in the bone marrow. Bone marrow aspirate, trephine biopsy, and clot section were compared for the detection of focal lesions in a series of 5 patients, 3 of who presented with a history of fever and 2 were already diagnosed cases of Hodgkin lymphoma. Focal lesions were detected in the 5 cases in the clot section alone, whereas bone marrow aspirate and trephine biopsy did not show any focal lesion. Granulomatous infiltration was detected in 3 patients, and lymphomatous infiltration was detected in 2 patients in the clot section, whereas bone marrow aspirate and trephine biopsy were negative for any focal lesion in all 5 cases. A clot section is particularly useful in the detection of bone marrow lesions with a focal distribution. Hence, it must be studied alongside bone marrow aspirate smears, touch smears, and trephine biopsy to increase the diagnostic yield., Competing Interests: None

Objective: To determine the histological outcome of pancytopenia cases on bone marrow trephine biopsy and to see the frequency of various causes of pancytopenia in our population. Study Design: Descriptive study. Place and Duration of Study: Pathology department, Combined Military Hospital (CMH), Kharian (Pakistan). One year (Jan 2015-Dec 2015). Material and Methods: Two hundred bone marrow trephine biopsies were done in one year (2015), out of which 40 were done for evaluation of pancytopenia. The criteria for diagnosis of pancytopenia were; haemoglobin less than 10 g/dl, total leukocyte count (TLC) less than 4.0 x 109/l and platelet count less than 100,000 x 109/l. Patients with pancytopenia secondary to drugs, chemotherapy and radiotherapy were excluded from the study. Trephine biopsies showing marked crushing and having inadequate material were also excluded from the study. Biopsies were processed, slides made and examined under light microscope by haematologist and histopathologist. Frequencies of various causes of pancytopenia diagnosed on histopathology were calculated. The findings were analyzed by using SPSS version 10.0. Result: Out of 40 cases of pancytopenia, male to female ratio was 3:2. The age range was between 1 year to 75 years. Histopathological analysis of bone marrow trephine biopsies revealed megaloblastic anaemia as the most common cause of pancytopenia (30%), followed by aplastic anaemia (25%) and hypersplenism (15%). Conclusion: Megaloblastic anaemia is the most common cause of pancytopenia in our population as compared to aplastic anaemia mentioned in most of the international studies. This indicates prevalence of nutritional deficiency in our population and megaloblastic anaemia must be kept at top of list while evaluating pancytopenia cases. Early diagnosis and treatment of megaloblastic anaemia will prevent any further complication of this disease. [ABSTRACT FROM AUTHOR]

Most guidelines suggest that only the bone marrow aspirate (BMA) is necessary to assess residual disease following intensive chemotherapy for Acute Myeloid Leukemia (AML) with the bone marrow trephine biopsy (BMTB) recommended in cases of a poor quality BMA. We performed a retrospective study evaluating this in a cohort of patients receiving intensive chemotherapy for AML. Residual disease was assessed by morphological examination of the BMA and BMTB ± immunohistochemistry. Of the 647 marrows 32.6% were interim marrows performed prior to peripheral count recovery, 41.7% were end of induction (EOI) marrows and the remaining were ‘other marrows’. The BMA and BMTB findings were concordant in 92.8% of cases. The BMTB led to a change in diagnosis from ‘no leukemia’ to ‘residual leukemia’ in 5.2% of interim, 3.7% of EOI and 2.4% of ‘other’ marrows. The BMA alone had a sensitivity of 86.8% in detecting residual leukemia and of 82.3%, 82.5% and 94.2% for interim, EOI and ‘other marrows’, respectively. Despite the high concordance between the BMA and the BMTB the poor sensitivity of the BMA in detecting residual leukemia, particularly at EOI, may lead to an overestimation of the complete remission rates which may have therapeutic and clinical trial implications. [ABSTRACT FROM AUTHOR]

This study aimed to document the morphological and immunophenotypic features, and describe the diagnostic features of bone marrow ( BM) involvement in human herpes virus 8 Multicentric Castleman disease ( HHV8- MCD). BM trephine biopsy ( BMTB) specimens from 28 patients were revisited. Samples were evaluated for expression of CD3, CD20, CD138, CD68R, glycophorin C, CD42b, HHV8-latency-associated nuclear antigen ( LANA1), Epstein-Barr virus-encoded small RNA and light chains. Presence of significant numbers of HHV8- LANA1+ lymphoid/plasmacytic cells, noted in 10/28 cases, was indicative of BM involvement and was associated with low CD4 and CD8 counts in peripheral blood. The characteristic morphological appearance of MCD seen in lymph nodes is a rare finding in BMTB. 4/5 cases with lymphoid aggregates were involved by MCD, whereas 6/23 cases without lymphoid aggregates were involved by MCD ( P = 0·023). 9/18 cases with hypercellular marrow were involved by MCD, whilst only 1/8 cases with normo/hypocellular marrow showed involvement by MCD ( P = 0·070). While 9/21 cases with increased marrow reticulin were involved by MCD, none of the cases with no increase in reticulin were involved by MCD ( P = 0·080). Reactive plasmacytosis is a frequent finding. We conclude that bone marrow is involved in a significant proportion of patients with MCD (36%), and involvement can be identified by HHV8- LANA1 immunohistochemistry. [ABSTRACT FROM AUTHOR]

Background: The bone marrow is frequently involved in variety of cases presenting with hematological and non-hematological disorders, which are diagnosed by two separate but interrelated techniques such as bone marrow aspiration (BMA) and bone marrow biopsy (BMB). Aim: This study was aimed to assess the diagnostic value of the BMA and BMB and role of both the procedures to reach final diagnosis when done simultaneously. Settings and Design: It was a prospective study. The findings of BMA smears were correlated with BMB sections and data obtained was analysed. Materials and Methods: BMA and BMB were performed on 50 patients. Criteria of inclusion included the main indications for performing this procedure, the availability of full medical records and patient consent. The patients had a male to female sex ratio of 1.6:1 and a wide age range from 4 years to 74 years. Results: In the present study, the main indications for bone marrow examination were categorized. Out of 50 cases studied, in 23 cases, a strong positive correlation between BMA and BMB was noted. However, it was found that in the cases of aplastic anaemia, different phases of myeloproliferative neoplasm (MPN), multiple myeloma, tubercular granulomas and hemato-lymphoid neoplasm, involvement of the marrow was detected better in bone marrow biopsies. Conclusion: The study concludes that preparations of aspirate and trephine biopsy are easy, rapid and complementary to each other in majority of the lesions. The advantage of both the procedures done together enabled us to study the cytomorphology of the cells along with the pattern of distribution of the cells depending on the cases, hence help in making the diagnosis accurately.

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Myelodysplastic syndrome (MDS) represents a heterogeneous group of clonal disorders of haematopoietic bone marrow (BM) stem cells manifesting as ineffective haematopoiesis and morphologically visible dysplasias, leading to peripheral cytopenias involving one or more blood cell lineages. The clinical course of the disease is variable and individual. It may lead either to the onset of fatal cytopenias due to progressive BM failure or, on the contrary, to the development of secondary acute myeloid leukaemia (AML). Diagnosis of the disease requires close correlation of the clinical picture, laboratory parameters and standardized evaluation of BM biopsy. Despite some progress in the treatment of patients with higher risk MDS (IPSS group int-2 and high), the current therapeutic options are limited and usually allogeneic haematopoietic stem cell transplantation, chemotherapy, supportive care and hypomethylating therapy may be considered. From 2008-2014, 76 patients were identified with high-risk MDS in our biopsy register who were treated with chemotherapy, the hypomethylating agent azacytidine or stem cell transplantation and whose bone marrow biopsies were available before and after treatment. The effect of the applied therapy was evaluated with focusing on the histopathological type of MDS before and after therapy and also on any change of the histo-morphological picture, particularly the BM blast count, progression to secondary AML and progression of myelofibrosis. The series consisted of 76 patients (47 men and 29 women); the average age was 62 years (27-82 years). The most common type of high-risk MDS was RAEB 2 (32 patients) and secondary AML (21 patients). 39 patients were treated only with the hypomethylating agent azacytidine; in 12 cases chemotherapy was also administered. 22 patients were treated with chemotherapy alone. In 3 patients, only information about peripheral stem cell transplantation was available, the total number of transplantations was 7. Hypomethylating therapy resulted in: a) blast cell count reduction in 16% of cases, b) disease stabilization without striking changes of the morphological picture in nearly 42% of cases, c) rapid disease progression despite therapy in approx. 35% of cases and d) gradual progression of myelofibrosis during the disease course in 8% of cases. Whether the progression of fibrosis represents an effect of hypomethylating treatment or is part of the natural course of MDS remains unknown, the same is true for the persistence or progression of cytopenia/s. [ABSTRACT FROM AUTHOR]

Objectives Bone marrow (BM) aspiration and trephine biopsy is one of the most valuable procedures in the evaluation of hematological disorders. There is a shortage of published literature regarding the indications, procedure, and outcome of bone marrow examination (BME) in neonates and infants. The aim of the present study is to analyze the common indications of performing BME and to assess the spectrum of disorders diagnosed from BM of neonates and infants. Methods A retrospective analysis of BMEs performed in infants over a period of 5 years, between 2009 and 2013 was done. Results and discussion A total of 297 BME were performed on 285 infants, which constitutes 10.3% of pediatric BME procedures during the same period. In our institute, BME is routinely performed by trained pathologists from posterior superior iliac spine in children including infants and neonates with an overall sample adequacy of 97%. Evaluation of cytopenias and suspicion of storage disorder were the most common indications for BME procedure, while acute leukemias and storage disorders were the most common diagnoses offered in infant BM. Conclusions Posterior superior iliac spine is a good site of BME in neonates and infants. BM trephine biopsy is a difficult procedure in this age group, however remains indispensable in situations where an infiltrative pathology is suspected. BME not only helps to make specific diagnoses but should also be used as an extremely valuable, quick, and economically viable procedure to exclude major hematological disorders including certain forms of storage disorder and hematological malignancy in this age group. [ABSTRACT FROM AUTHOR]

Background: The bone marrow is frequently involved in variety of cases presenting with hematological and non-hematological disorders, which are diagnosed by two separate but interrelated techniques such as bone marrow aspiration (BMA) and bone marrow biopsy (BMB). Aim: This study was aimed to assess the diagnostic value of the BMA and BMB and role of both the procedures to reach final diagnosis when done simultaneously. Settings and Design: It was a prospective study. The findings of BMA smears were correlated with BMB sections and data obtained was analysed. Materials and Methods: BMA and BMB were performed on 50 patients. Criteria of inclusion included the main indications for performing this procedure, the availability of full medical records and patient consent. The patients had a male to female sex ratio of 1.6:1 and a wide age range from 4 years to 74 years. Results: In the present study, the main indications for bone marrow examination were categorized. Out of 50 cases studied, in 23 cases, a strong positive correlation between BMA and BMB was noted. However, it was found that in the cases of aplastic anaemia, different phases of myeloproliferative neoplasm (MPN), multiple myeloma, tubercular granulomas and hemato-lymphoid neoplasm, involvement of the marrow was detected better in bone marrow biopsies. Conclusion: The study concludes that preparations of aspirate and trephine biopsy are easy, rapid and complementary to each other in majority of the lesions. The advantage of both the procedures done together enabled us to study the cytomorphology of the cells along with the pattern of distribution of the cells depending on the cases, hence help in making the diagnosis accurately. [ABSTRACT FROM AUTHOR]

We investigated the value and degree of agreement between a sensitive four-colour flow cytometry (FC) method and bone marrow trephine (BMT) biopsy for detecting minimal residual disease (MRD) in 82 chronic lymphocytic leukaemia (CLL) cases. Concordance was 85%, with 15% of cases discrepant (six BMT-positive/FC-negative and six BMT-negative/FC-positive cases). FC-positive/BMT-negative cases had a low-level MRD by FC (0.05-0.9%), whereas BMT-positive/FC-negative cases had significant residual nodular disease. We conclude that FC and BMT biopsy are complementary investigations for MRD assessment in CLL, and both should be considered in the routine setting to assess MRD in CLL. [ABSTRACT FROM AUTHOR]

Abstract: Evaluation of remission in adult acute lymphoblastic leukemia (ALL) normally relies on cytologic evaluation and flow-cytometric analysis. The diagnostic impact of bone marrow trephine biopsies has not been studied so far. We investigated 26 biopsies of 16 patients with T-ALL. Double fluorescent immunostaining with TdT and CD3 was performed. Corresponding cytologic evaluation and flow-cytometric data were available. In 17 of 26 investigations, the results were concordant (either positive or negative). In one examination, residual blasts were not recognized by trephine biopsy, but by other methods. By contrast, in eight investigations, the leukemic blasts were found only in the bone marrow trephine biopsies. Regarding the evaluation of remission of T-ALL, in our retrospective study, bone marrow trephine biopsies with double immunostaining were found to be sensitive and specific for the detection of residual blasts. This method may add to the conventional cytology and flow-cytometric analysis. [Copyright &y& Elsevier]

Accurate staging of Hodgkin’s lymphoma (HL) is necessary in selecting appropriate treatment. Bone marrow trephine biopsy (BMB) is the standard procedure for depicting bone marrow involvement. BMB is invasive and explores a limited part of the bone marrow. 18F-FDG PET/CT is now widely used for assessing response to therapy in HL and a baseline study is obtained to improve accuracy. The aim of this retrospective analysis was to assess whether routine BMB remains necessary with concomitant 18F-FDG PET/CT. Data from 83 patients (newly diagnosed HL) were reviewed. All patients had received contrast-enhanced CT, BMB and 18F-FDG PET/CT. Results of BMB were not available at the time of 18F-FDG PET/CT imaging. Seven patients had lymphomatous involvement on BMB. Four patients had bone involvement on conventional CT (two with negative BMB). All patients with bone marrow and/or bone lesions at conventional staging were also diagnosed on 18F-FDG PET/CT scan. PET/CT depicted FDG-avid bone/bone marrow foci in nine additional patients. Four of them had only one or two foci, while the other had multiple foci. However, the iliac crest, site of the BMB, was not involved on 18F-FDG PET/CT. Osteolytic/sclerotic lesions matching FDG-avid foci were visible on the CT part of PET/CT in three patients. MRI ordered in three other patients suggested bone marrow involvement. Interim and/or end-therapy 18F-FDG PET/CT documented response of FDG-avid bone/bone marrow foci to chemotherapy in every patient. 18F-FDG PET/CT highly improves sensitivity for diagnosis of bone/bone marrow lesions in HL compared to conventional staging. [ABSTRACT FROM AUTHOR]

Objectives: To better realize the features of peripheral blood (PB), bone marrow (BM) aspirate and especially BM trephine biopsy in atypical chronic myeloid leukemia (aCML). Methods: We studied PB, BM smears in 35 cases of aCML and compared with 84 cases of chronic granulocytic leukemia chronic phase (CGL-CP), 39 cases of chronic myelomonocytic leukemia (CMML). In addition, we evaluated characteristics of BM trephine biopsies in 21 cases of aCML and compared with 68 cases of CGL-CP, 20 cases of CMML. Results: All aCML patients presented with leukocytosis (median WBC 17.3 × 109/L), 48% had moderate anemia, and 85% had thrombocytopenia. Values of monocytes, eosinophils, basophils, percentage of immature granulocytes and monocytes (0.63 ± 0.41 × 109/L, 0.18 ± 0.16 × 109/L, 0.09 ±0.08 × 109/L, 6.27 ± 3.09%, and 2.46 ± 1.75%, respectively) were useful in distinguishing aCML from CGL-CP and CMML groups. The BM smears showed that striking dysgranulopoieis (100%), dyserythropoiesis (48.6%), percentage of blasts, nucleated erythrocytes, monocytes, eosinophils, and basophils (2.45 ± 2.06%, 7.76 ± 2.89%, 1.30 ± 1.21%, 1.47 ± 1.60%, and 1.15 ± 1.08%, respectively) were all important parameters for a diagnosis of aCML. On BM trephine sections, aCML was characterized as hypercellularity, a moderate degree of reticulin fibrosis (71.4%), lymphocytopenia (76.2%), plasmacytopenia (90.5%), abnormal localization of immature precursors (28.5%), and absence of eosinophilia, basophilia, monocytosis. Furthermore, BM imprints, immunohistochemical, and cytochemical staining findings provided important morphological reference to BM trephine sections and made the identification of nucleated cells more convenient. Conclusions: Besides the findings observed in PB and BM aspirate, features of BM trephine biopsy (including BM trephine section, BM imprint, immunohistochemical, and cytochemical staining) can also aid in the diagnosis of aCML. [ABSTRACT FROM AUTHOR]

Abstract: We identified different phenotypic subsets among 62 cases of chronic myeloid leukemia (CML) in blast crisis (BC) (26% B-lymphoblastic, and 74% various myeloblastic subsets) on bone marrow trephines and correlated the blast-phenotype with cytogenetics. Five of myeloid-BC had an associated 3q26 abnormality and two of these showed a megakaryoblastic-phenotype. While myeloid-BC was associated with additional copies of Philadelphia (Ph) (29%) (p =0.08), numerical abnormalities (51%) (p =0.007), trisomy-8 (29%) (p =0.08) and 17p-loss (22%), none of lymphoid-BC showed these abnormalities. Among myeloid-BC, CD34-negative cases were more often associated with trisomy-8, 17p-loss and numerical abnormalities, and the CD117-negative subset with additional copies of Ph (p <0.05). [Copyright &y& Elsevier]

Abstract: Atypical chronic myeloid leukemia (aCML) as defined by the WHO classification is a rare hematopoietic stem cell disorder, which shows both myeloproliferative as well as myelodysplastic features. Because of the presence of neutrophilic leukocytosis, aCML may resemble chronic myelogenous leukemia. However, in contrast with the latter, aCML lacks a Philadelphia chromosome or the BCR/ABL fusion gene. The molecular pathogenesis of aCML and its relationship to other myeloproliferative neoplasms is unknown. To clarify these points, the presence of JAK2 V617F was examined by a retrospective analysis of archival specimens obtained from two large medical institutions. Paraffin-embedded bone marrow (BM) trephines and clot sections were examined by an allele-specific TaqMan PCR suitable for use with decalcified tissue. Fifty-nine cases of Philadelphia (Ph) chromosome negative chronic myeloproliferative neoplasms (CMPN) and normal bone marrows (BM) served as controls. None of the nine amplifiable cases of aCML and none of the normal BM controls showed a JAK2 V617F mutation, in contrast to 45/59 (76%) of the Ph chromosome negative CMPN cases. Atypical CML should therefore be considered as a JAK2 negative chronic myeloid neoplasm that remains properly categorized, alongside chronic myelomonocytic leukemia and juvenile myelomonocytic leukemia, within the WHO group of myelodysplastic/myeloproliferative neoplasms. [Copyright &y& Elsevier]

Bone marrow (BM) examination is a routine staging procedure in follicular lymphoma (FL). Commonly, both BM histology as well as flow cytometry (FCM) of BM aspirates are performed. In order to compare the diagnostic value of these two techniques, we retrospectively evaluated trephine BM biopsies and listmode data of patients with a confirmed diagnosis of FL, obtained in parallel during a 5-year period. One hundred and thirty nine specimens from 91 patients with FL were eligible for analysis. After joint review, nine cases (6.5%) were reclassified, either in histology (six cases) or FCM (three cases). Seventy nine specimens (57%) showed no infiltration with both methods. Sixty specimens (43%) were scored positive for BM involvement by any of the two techniques. Concordant positive results were obtained in 41 cases (68% of positive BM). False negative results were obtained by FCM in 14 cases (23% of positive BM) and by histology in five cases (8%). Discrepant results between BM histology and FCM are frequent in patients with FL, most likely due to the predominantly paratrabecular infiltration and fibrosis typical for FL. Due to the lower false negative rate, trephine BM biopsy remains crucial for the detection of BM involvement in FL. [ABSTRACT FROM AUTHOR]

Summary: B-cell chronic lymphocytic leukemia (B-CLL) consists of at least 2 subtypes with either somatically mutated or unmutated immunoglobulin heavy-chain variable region (IgVH) genes. A prognostic significance of the infiltration pattern in bone marrow trephine biopsy has been described before. The combined pattern analysis and detection of 70-kd ζ-associated protein (ZAP-70) expression in formalin-fixed, paraffin-embedded bone marrow trephines has not been investigated so far. To evaluate the relationship between ZAP-70 expression, mutation status, and the infiltration pattern in B-CLL, we analyzed bone marrow trephine biopsies from B-CLL patients (n = 35). The expression of ZAP-70 was related to the infiltration type: in all samples with diffuse infiltration pattern, the leukemic cells showed ZAP-70 staining, whereas leukemic cells in a nodular infiltration pattern were negative. By contrast, the mixed-pattern type showed a variable ZAP-70 expression. Besides definitely negative or positive ZAP-70 expression, a few samples showed a faint ZAP-70 staining, and the classification into the positive or negative group was difficult. In addition, the infiltration type was related to the mutation status in a subset of samples: mutation of the IgVH gene was restricted to the nondiffuse infiltration pattern and was not found in cases with diffuse infiltration of bone marrow. The expression of ZAP-70, detected by an immunohistochemical assay and also by real-time quantitative reverse transcriptase–polymerase chain reaction assigned 83% of the chronic lymphocytic leukemia cases to the suspected immunoglobulin mutation subtype. In 2 patients with ZAP-70 expression, a mutated IgVH status was found. These cases exhibited a mixed pattern of infiltration. We conclude that the pure nodular type of marrow infiltration in B-CLL is associated with IgH hypermutation and ZAP-70 negativity, whereas the predominantly diffuse type of infiltration reveals unmutated IgH genes with ZAP-70 overexpression. The mixed type of infiltration is displayed by mutated as well as unmutated cases with a varying pattern of ZAP-70 expression. [Copyright &y& Elsevier]

Akkaya H, Dogan O, Agan M, Dincol G. The value of tatrate resistant acid phosphatase (TRAP) immunoreactivity in diagnosis of hairy cell leukemia. APMIS 2005;113:162–6.Hairy cell leukemia (HCL) is a rare chronic B-cell lymphoproliferative disorder characterized by splenomegaly, pancytopenia, and circulating atypical lymphocytes with circumferential cytoplasmic projections. We investigated the specificity and the sensitivity of anti-TRAP antibody immunoreactivity in 57 cases of HCL. We found that there is a statistically highly significant difference between TRAP immunoreactivities of the study and the control groups, and HCL can be diagnosed by TRAP immunoreactivity in bone marrow trephine biopsy materials with a specificity of 98.27 % and a sensitivity of 100%. [ABSTRACT FROM AUTHOR]

A survey of morbidity and mortality of bone marrow aspiration and trephine biopsy was carried out for the British Society of Haematology, covering the 12 months of 2002. Fifty-three centres reported 13 506 procedures, comprising 3927 aspiration biopsies and 9579 combined procedures. There were 17 adverse events including nine instances of haemorrhage, four infections and one haemorrhage complicated by infection. Two trephine biopsy needles broke during the procedure. One patient suffered considerable pain for 2 weeks. The adverse event may have contributed to death in two patients and in a third patient was life-threatening. Risk factors for adverse events were identified. [ABSTRACT FROM AUTHOR]

Severe retroperitoneal hemorrhage represents an infrequent and serious complication of bone marrow biopsy. A 53-year-old man, diagnosed with polycythemia vera 12 years earlier, was submitted to a bone marrow biopsy due to the appearance of anemia with clinical and hematological features suggesting myelofibrotic transformation, a diagnosis that was confirmed by the marrow study. At 2 h of a right anterior iliac bone marrow trephine biopsy, the patient suddenly developed severe pain in the area of the biopsy, with antialgic flexion of the right leg. Computed tomographic (CT) scan of the abdomen showed a 5 x 9.5 cm hematoma in the right iliac and psoas muscles. The patient was initially managed with analgesics and transfusional support, but the pain persisted and a continuous fall in the hematocrit was observed in the following days. Angiographic examination of the right external iliac artery showed contrast extravasation arising from the circumflex iliac branch, which was embolized using polivinyl alcohol particles and one coil. Following such procedure, the patient recovered uneventfully and was discharged in good condition a few days later. This case illustrates the effectiveness of an endovascular approach in providing a fast and minimally invasive treatment for this life-threatening complication of bone marrow trephine biopsy. [ABSTRACT FROM AUTHOR]

Background and Objectives: To compare bone marrow biopsy (BMB) and PET/CT in detecting bone marrow involvement in Hodgkin's lymphoma MATERIAL AND METHODS: Retrospective analysis of 65 patients with both tests in the initial staging or in relapse with special attention to the PET/CT uptake pattern., Results: In 3 patients (4.6%), the BMB showed bone marrow involvement with the PET/CT being positive in them all: 2 with diffuse+multifocal pattern and one diffuse only. In 11 additional patients (total 14/65, 21%), bone marrow involvement was diagnosed by PET/CT because bone marrow uptake was above hepatic one. The pattern was focal only in 2 cases, multifocal in 5, diffuse in 3 and diffuse+multifocal in one. In these last 4 cases the BMB showed an unspecific myelopathy., Conclusions: PET/CT detects all cases with BMB affected and many that escape to biopsy, however when the uptake pattern is diffuse it could be by involvement or reactive hyperplasia and in those cases the BMB should be done., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Patient: Male, 19 FINAL DIAGNOSIS: Hyperleukocytosis • thrombocytosis, Symptoms: Hyperleukocytosis • retroperitoneal hemorrhage • thrombocytosis, Medication: - Clinical Procedure: Bone marrow trephine biopsy Specialty: Hematology • Radiology., Objective: Diagnostic/therapeutic accidents., Background: Bone marrow (BM) trephine biopsy is generally a safe procedure, but adverse events such as retroperitoneal hemorrhage (RPH) may occur. We report 3 cases of this complication., Case Report: A 19-year-old male with thrombocytopenia and coagulopathy underwent BM trephine biopsy to confirm relapse of acute lymphoblastic leukemia. Two hours later, he developed severe hypotension and a CT scan revealed a massive RPH, and was treated conservatively. The RPH recurred 2 weeks after chemotherapy and was successfully treated with gel foam embolization. A 55-year-old male with coagulopathy underwent BM trephine biopsy for hyperleukocytosis and thrombocytosis. He developed a large RPH preceded by left lumbar dermatome sensory neuropathy. He was treated conservatively. A 56-year-old overweight woman on aspirin underwent BM trephine biopsy for polycythemia. Twelve hours later she developed severe abdominal pain with hypotension. A CT scan showed a massive RPH and secondary hemothorax. She was treated conservatively and the RPH resolved after several months., Conclusions: We and others showed that myeloproliferative neoplasm, quantitative or qualitative platelet abnormalities, aspirin, coagulopathy, and obesity are associated with development of RPH following BM trephine biopsy. Early diagnosis and intervention are crucial. Correction of coagulopathy and cessation of anti-platelet treatment prior to biopsy can prevent this serious complication.