An approach to the assessment of lymphoid infiltrates in the bone marrow trephine biopsy

Lymphoid infiltrates, benign and malignant, are encountered routinely in bone marrow trephine biopsies and require a systematic approach to reach a final diagnosis. Like any other histopathological finding, evaluation of lymphoid infiltrates requires interpretation in light of the clinical context to direct investigations appropriately and ensure a timely and accurate diagnosis. Work-up should be undertaken within a specialist integrated haematological malignancy diagnostic service (SIHMDS) to ensure appropriate investigations are available and used where required. Malignant lymphoid infiltrates may be overt and easily identified on routine stains and confirmed using an appropriate immunohistochemical panel or they may be subtle requiring further work up and correlation with other diagnostic modalities, as will be highlighted using illustrative cases. Clinical context remains paramount.