Lymphoid Nodules of Bone Marrow: Normal and Abnormal

Abstract

A study of consecutive bone marrow aspirates from 365 patients without lymphoproliferative disorder, ten patients with chronic lymphocytic leukemia (CLL), and 25 patients with malignant lymphoma disclosed a clear separation of normal from abnormal lymphoid nodules (LN). Normal LN were found in 47% of patients and were classified into lymphoid follicles and lymphoid infiltrates. A new entity, nodular lymphoid hyperplasia (NLH), was diagnosed on ten bone marrows which contained a low-power field displaying four or more lymphoid nodules or showed a lymphoid nodule larger than 0.6 mm. The clinical significance of nodular lymphoid hyperplasia remains unknown; in certain cases it represents a precursor state of a mature lymphocytic lymphoproliferative disorder. Nodular aggregates in CLL are of the infiltrate type and exhibit a tendency to confluence. Eleven of the 25 patients with malignant lymphoma displayed lymphoreticular nodules which were cytologically similar to the original lymphoma and different from normal LN. Two patients, one with reticulum cell sarcoma and one with Hodgkin’s disease, showed NLH of the bone marrow. Bone marrow LN in patients with an established diagnosis of mature lymphocytic lymphoma have to be interpreted with the utmost caution. Confluence of LN, irregular shapes, and the presence of prolymphocytes and lymphoblasts speak for lymphomatous nodules. Additional clinicopathologic studies are necessary to sharpen the distinction between NLH and well-differentiated lymphoproliferative disorders.

Bone Marrow Histology in Waldenström's Macroglobulinaemia

“…The clinical features of WM are due to the presence of monoclonal IgM and the accumulation of lymphoid cells causing bone marrow failure and enlargement of the spleen, liver and lymph nodes. Nevertheless, as pointed out (19), the differential diagnosis of macroglobulinaemia may be very difficult, and in some cases is quantitative rather than qualitative (20). However, as previously shown (21) careful follow-up investigations and sequential biopsies will clarify the picture.…”

Frequencies and patterns of bone marrow involvement in non‐hodgkin lymphomas: Observations on the value of bilateral biopsies

“…When there is no lymph node or extranodal site with an independent tissue diagnosis, the diagnosis of malignant lymphoma should be made with great caution, since occasionally even extensive lymphoid aggregates may be found confined to the bone marrow of patients who do not have generalized lymphoma by clinical or pathological criteria. Rywlin et al [20] reported ten such patients with nodular lymphoid hyperplasia of the bone marrow and noted no progression of the disorder in all five of their patients available for study over a 2-2.S.year follow-up period. More recently Mennemeyer and Kjeldsberg [22] reported florid lymphoid replacement of the bone marrow in an 80-year-old man who had no autopsy evidence of ex tramedullary lymphoma nine months after diagnosis.…”

“…In general, both quantitative and qualitative factors help in this decision. In a recent review Rywlin et al [20] noted that the published frequency of benign lymph nodules in random bone marrow examinations ranged from 1-9% in aspirated or biopsy material and 21-62% in autopsy material. In their own series, however, the frequency was 47%, which they attributed to the higher age of their patients (71.9 years) and their marrow concen· tration technique.…”

Follicular dendritic cells in bone marrow lymphoproliferative diseases: an immunohistochemical study including a new paraffin‐resistant monoclonal antibody, DR53

“…Of the bone marrow biopsies with non-malignant infiltrates only those that contained well-defined lymphoid aggregates were considered in our study, excluding the purely interstitial lymphoid reactions. Their benign nature was based upon the classical criteria of number, size, localization, and cellular components 7,8 , associated with the immunohistochemical data 9,10 .…”