Abstract

Background and Objective: Bone marrow biopsy is an integral part of staging work-up and prognostication for Hodgkin and non-Hodgkin lymphoma (NHL).Objective of this study is to study and compare the diagnostic findings of aspirates and trephine biopsies in lymphomas.

Methods: A prospective study was conducted on sixty two cases of Bone marrow aspirates and trephine biopsies from biopsy proven lymphomas (Hodgkins and Non Hodgkins Lymphoma) for the period of eighteen months from February 2016 to August 2017. Bone marrow biopsies were taken with Jamshidi needle. Trephines were fixed in 10% buffered formalin for 24 hours and then placed in a decalcifying medium (EDTA Tris buffer) for 2 days at room temperature. The serial sections were stained by hematoxylin and eosin and reticulin stains. The bone marrow aspirates and peripheral smears were stained using Leishman stain.

Results and Discussion: The study included 6 cases of Hodgkins lymphoma and 56 cases of Non Hodgkin lymphomas. Median age of presentation was 55.2 years. Male: female ratio of 3.4: 1 was observed. A total of 22 cases (35.5%) showed lymphoma infiltrating the bone marrow. The most common pattern of involvement in the study is diffuse pattern (31.8%),  followed by mixed pattern (22.7%),focal pattern (18.2%), paratrabecular pattern(9%), interstitial pattern(9%) and nodular pattern of involvement(9%).10 out of 22 bone marrow positive cases showed fibrosis in the trephine biopsy(45%). The highest incidence of marrow involvement was noted in CLL/SLL, hairy cell leukemia(100%), followed by DLBCL(45%) and follicular lymphoma(43%).Atypical lymphoid cells were seen in the bone marrow aspirate in 11 out of 22 cases (50%) that showed marrow involvement in trephine biopsy. 9 out of 62 cases (15%) showed circulating tumour cells in the peripheral blood.  

Conclusion: Lymphomas in the bone marrow trephine have characteristic infiltration patterns specific to different subtypes of lymphomas. Additional finding like fibrosis is frequent in bone marrow with lymphoma infiltration. The bone marrow aspirate helps in better appreciation of atypical lymphoid cells. Patient with lymphoma should undergo Bone marrow trephine biopsy because of its higher sensitivity compared to Bone marrow aspirate.

Keywords: Bone marrow aspirate; bone marrow trephine; lymphoma infiltration; patterns of involvement; fibrosis.