Bone marrow aspirate and biopsy: a pathologist's perspective. II. interpretation of the bone marrow aspirate and biopsy

Abstract

Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Morphologic evaluation of the bone marrow aspirate and biopsy has recently been supplemented by increasingly sophisticated ancillary assays, including immunocytochemistry, cytogenetic analysis, flow cytometry, and molecular assays. With our rapidly expanding knowledge of the clinical and biologic diversity of leukemia and other hematologic neoplasms, and an increasing variety of therapeutic options, the bone marrow examination has became more critical for therapeutic monitoring and planning optimal therapy. Sensitive molecular techniques, in vitro drug sensitivity testing, and a number of other special assays are available to provide valuable data to assist these endeavors. Fortunately, improvements in bone marrow aspirate and needle technology has made the procurement of adequate specimens more reliable and efficient, while the use of conscious sedation has improved patient comfort. The procurement of bone marrow specimens was reviewed in the first part of this series. This paper specifically addresses the diagnostic interpretation of bone marrow specimens and the use of ancillary techniques.

Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS

“…Mycobacterium spp tend to produce granulomas, whereas M tuberculosis tends to produce granulomas with central caseating necrosis. Large tightly cohesive granulomas also suggest tuberculosis, whereas smaller, more loosely formed granulomas tend to be associated with MAI 12 24 28. Although H capsulatum more often produces lymphohistiocytic infiltrates, it can also produce granulomas 12 28.…”

“…Large tightly cohesive granulomas also suggest tuberculosis, whereas smaller, more loosely formed granulomas tend to be associated with MAI 12 24 28. Although H capsulatum more often produces lymphohistiocytic infiltrates, it can also produce granulomas 12 28. Although non-specific, these histological features can help in narrowing down the differential diagnosis in the appropriate clinical settings.…”

“…Demographic data, CBC, blood cultures, CD4 counts and HIV viral loads were collected for every patient. BMs were examined by standard methodology25 27 28 with Wright stain on aspirate smears, H&E stain and special stains (GMS/AFB) on core biopsy and/or clot section(s). Tissue sections were reviewed for evidence of granulomas or lymphohistiocytic infiltrates.…”

Pitfalls in obtaining and interpreting bone marrow aspirates: to err is human

“…Cell morphology can only be properly assessed when the cells are adequately and evenly separated, the cells are not crushed or distorted, the sample is sufficiently cellular and contains adequate numbers of particles, and the sample is not clotted or partly clotted 26. A dilute specimen may be the result of taking a large volume of marrow for supplementary tests.…”

Initial Diagnostic Workup of Acute Leukemia: Guideline From the College of American Pathologists and the American Society of Hematology

“…In general, an intact core biopsy specimen that is 1 cm or larger is considered optimal for diagnosis. [133][134][135]137,139 This specimen cannot consist largely of cortical or subcortical regions but, instead, must contain intact hematopoietic regions of the BM.…”