Lymphoid infiltrates in B cell non Hodgkin’s lymphoma: Comparing nuclear characteristics between lymph node and bone marrow; and evaluating diagnostic features of bone marrow infiltrates in paraffin embedded tissues

Article type: Research Article

Authors: Deverell, Mark H. | Best, Elizabeth | Salisbury, Jonathan R.^;

Affiliations: The Health Centre, Marylebone Road, March, Cambridge, UK | Department of Histopathology, King’s College School of Medicine, London SE5 9PJ, UK

Note: [] Address for correspondence: Dr. J.R. Salisbury, Department of Histopathology, King’s College School of Medicine, Bessemer Road, London SE5 9PJ, UK.

Abstract: Distinguishing non Hodgkin’s lymphoma from benign lymphoid aggregates in bone marrow is well recognised to be difficult. Our objective was to evaluate nuclear morphology, and to perform morphometry on benign and neoplastic lymphoid infiltrates, to establish if objective criteria were of value in the diagnosis of neoplasia. By comparing neoplastic infiltrates in bone marrow with infiltrates in lymph nodes, the validity of grading non Hodgkin’s lymphoma on the basis of bone marrow histology alone was assessed. 82 cases of B cell non Hodgkin’s lymphoma (44 low grade and 38 high grade), known to have both lymph node and bone marrow involvement at the time of presentation, were compared with bone marrow trephines containing reactive lymphoid infiltrates. The results suggest that in paraffin embedded tissue from bone marrow trephines, nuclear morphology, nuclear area and the nuclear contour index cannot, in most cases, be used to distinguish reactive from neoplastic lymphoid infiltrates although mean nuclear area supports a diagnosis of a neoplastic infiltrate if it can be shown that the nuclei are larger than would be expected in reactive infiltrates. Such differences are subtle and often not appreciable without the use of quantitative techniques. The frequent occurrence of discordant infiltrates in high grade lymphomas means grading of lymphoma on the basis of bone marrow appearances is often unrealistic.

Keywords: Non Hodgkin’s lymphoma, bone marrow, karyometry, computer assisted image processing

Journal: Analytical Cellular Pathology, vol. 14, no. 1, pp. 1-7, 1997