Arya Puthukkat Muraleedharan1, Prabhalakshmy Kuzhikkattil Krishnankutty2
BACKGROUND
In the evaluation of patients with non-Hodgkin lymphoma (NHL), determination of
bone marrow involvement is an integral part of staging work up. Peripheral blood
counts and examination of blood smears are also done in patients with lymphoma
as part of pre-treatment investigations.
METHODS
A cross sectional study of 78 patients with a prior histopathological diagnosis of
NHL was conducted. Peripheral blood counts were performed on an automated
haematology analyser to look for various cytopenias. Peripheral blood smears and
bone marrow aspirate (BMA) / imprint smears were examined in detail for atypical
lymphoid cells. Bone marrow trephine biopsies of these patients were studied to
assess the NHL involvement and the various patterns of involvement. Adjuvant
immunohistochemistry (IHC) was performed in bone marrow biopsies with scant
cellularity or crush artefact to discern the marrow involvement.
RESULTS
Bone marrow trephine biopsy showed involvement by lymphoma in 65.4 % cases.
The incidence of involvement was higher in B-cell lymphomas, especially in low
grade types. The predominant pattern of involvement was interstitial pattern (41.2
%). Discordant histology between bone marrow and the primary anatomic site
was found in 7.8 % of the cases, which was seen more in diffuse large B-cell
lymphomas. Majority of the patients with bone marrow infiltration by NHL had
anaemia (84.3 %). Bicytopenia and pancytopenia were also observed. On
peripheral blood smear examination atypical lymphoid cells were present in 23 %
cases.
CONCLUSIONS
Bone marrow examination is an important aspect in the diagnosis of NHL, because
of its both prognostic and therapeutic implications. Hence, the presence of atypical
lymphoid cells and other changes in the peripheral blood should be detected in
these patients.
