Background: Granulomas in bone marrow are an infrequent finding; however several diseases may be associated with granuloma formation and an etiologic diagnosis is essential. Bone marrow examination plays an important role in the diagnosis of various disorders associated with bone marrow granulomas and is useful in the investigation of pyrexia of unknown origin (PUO) as it leads to an etiological diagnosis in many of the cases. Aim: This study was undertaken to ascertain the frequency and etiological background of bone marrow granulomas. Material and methods: In the present study, forty seven cases with bone marrow granulomas were included. Clinical details, peripheral blood and marrow morphological findings were analyzed. Results: Pyrexia of unknown origin was the commonest presentation and anemia was noted in all cases. Twenty five cases had associated clinical conditions, including 7 with past history of tuberculosis and 8 with retroviral disease. Of the 47 cases, 7 showed granulomas in bone marrow aspiration, while bone marrow biopsy was diagnostic in all cases. Caseous necrosis was seen in 11(23.4%) cases. Acid fast bacilli were demonstrated in one bone marrow aspirate. Culture studies grew Brucella organisms in one case. Tuberculosis was the commonest in the present study as compared to other studies probably due to the endemicity of tuberculosis in this region. Conclusion: If the granuloma is associated with caseous necrosis and Langhan giant cells and correlated with clinical features, a possibility of the tuberculous etiology may be suggested to allow empirical treatment to be initiated before microbiological confirmation.

Follicular lymphoma (FL) is the most common indolent form of non Hodgkin lymphoma and characterized by initial response to treatment with inevitable relapse. Rituximab, is an anti CD20 monoclonal antibody, plays an important role in combination chemoimmunotherapy in treatment of symptomatic follicular lymphoma. Though rituximab is helpful in reducing the tumor burden in patients of follicular lymphoma, a significant proportion of patients were found to have resistance to rituximab and eventually progressed to high grade lymphoma. In this study we evaluated chemoimmunotherapy (CIR) resistant patients to know the incidence, predictive factors associated with CIR resistance and prognosis. This is a retrospective study, included 49 patients of follicular lymphoma, of these 12 (24.5%) demonstrated CIR resistance. On univariate analysis, high LDH values, advanced stage and high FLIPI score may predict the resistance of CIR therapy in initial stage of therapy. Overall, 7 patients (58.3%) progressed to high grade lymphoma (biopsy proven) and 2 (16.6%) died of disease progression in CIR resistant patients. Progressive free survival significantly reduced in CIR resistant patients (26 months) than CIR responders.