Introduction: Intra-sinusoidal infiltration (ISI) is a recently recognized pattern of bone marrow (BM) invasion, described as a frequent and occasionally prominent pattern of invasion in splenic marginal zone lymphoma (MZL) [1]. ISI was also found in other NHL types [2], but never as a “prominent” pattern. We have analysed 54 BM biopsies showing an ISI pattern by means of a quantitative approach. The purpose was to verify if the ISI pattern of BM invasion was specific of splenic MZL, and if ISI quantity on BM biopsy could represent a diagnostic criterion. Materials and Methods: Out of the 54 NHL, there were 31 (57.4%) MZL and 23 (42.6%) non-MZL: 6 MCL, 6 SLL/CLL, 4 FL, 4 DLBL, 1 PTC, 1 LDL and 1 ALCL. Thirty-five (64.8%) were primitive splenic (PSL) and 19 (35.2%) non-primitive splenic (non-PSL) lymphomas. Splenectomy was performed in 25 patients. Serial sections from BM biopsies, decalcified and embedded in paraffin, were stained with H.E., periodic acid Schiff (PAS), Giemsa and reticulin staining and the monoclonal antibodies anti CD45, CD20 and CD3. In selected cases, the analysis was supplemented by CD34, CD79a, CD76 (DBA44), CD8, CD30, CD5, CD4, TIA, anti-granzyme B and ALK immunostaining. The pattern and quantity of BM infiltrate was assessed on CD20 (or CD3) stained sections. The mean percentage of all neoplastic lymphocytes (ITOT) and the mean percentage of intrasinusoidal lymphocytes (ISI) was calculated by examining 10 areas for each case. Results: The mean ITOT for the whole series was 26.31 (SD +20.97; range 1-80). It was 21.57 in PSL and 35.05 in non-PSL (p=0.04); 22.58 in MZL and 31.34 in non-MZL (p=0.15). The mean ISI for the whole series was 6.07 (SD +5.29; range 0.1-21.3). It was 5.23 in PSL and 7.62 in non-PSL (p=0.1); 5.70 in MZL and 6.58 in non-MZL (p=0.56). In PSL, ISI quantity was greater in MZL (5.83) than in non-MZL (2.83) (p=0.1), and a direct correlation was found between the weight of the spleen and ITOT (r=0.41, p=0.04), but not ISI quantity (r=0.04, p=0.84). Conclusions. The intrasinusoidal pattern of BM invasion is particularly frequent in MZL and PSL [1], but not specific. Moreover, ISI quantity is not indicative of splenic MZL. Therefore, the hypothesis of splenic MZL, based on the presence or quantity of ISI on bone marrow biopsy, should be supported by a complete immunophenotyping and cytogenetic analysis of the bone marrow infiltrate. 1) Franco V et al. Blood 2003; 101:2464-2472 2) Costes V et a. Br J Haematol 2002; 119:916-922
Intrasinusoidal bone marrow infiltration and splenic marginal zone lymphoma
PALESTRO, Giorgio;PICH, Achille
2004-01-01
Abstract
Introduction: Intra-sinusoidal infiltration (ISI) is a recently recognized pattern of bone marrow (BM) invasion, described as a frequent and occasionally prominent pattern of invasion in splenic marginal zone lymphoma (MZL) [1]. ISI was also found in other NHL types [2], but never as a “prominent” pattern. We have analysed 54 BM biopsies showing an ISI pattern by means of a quantitative approach. The purpose was to verify if the ISI pattern of BM invasion was specific of splenic MZL, and if ISI quantity on BM biopsy could represent a diagnostic criterion. Materials and Methods: Out of the 54 NHL, there were 31 (57.4%) MZL and 23 (42.6%) non-MZL: 6 MCL, 6 SLL/CLL, 4 FL, 4 DLBL, 1 PTC, 1 LDL and 1 ALCL. Thirty-five (64.8%) were primitive splenic (PSL) and 19 (35.2%) non-primitive splenic (non-PSL) lymphomas. Splenectomy was performed in 25 patients. Serial sections from BM biopsies, decalcified and embedded in paraffin, were stained with H.E., periodic acid Schiff (PAS), Giemsa and reticulin staining and the monoclonal antibodies anti CD45, CD20 and CD3. In selected cases, the analysis was supplemented by CD34, CD79a, CD76 (DBA44), CD8, CD30, CD5, CD4, TIA, anti-granzyme B and ALK immunostaining. The pattern and quantity of BM infiltrate was assessed on CD20 (or CD3) stained sections. The mean percentage of all neoplastic lymphocytes (ITOT) and the mean percentage of intrasinusoidal lymphocytes (ISI) was calculated by examining 10 areas for each case. Results: The mean ITOT for the whole series was 26.31 (SD +20.97; range 1-80). It was 21.57 in PSL and 35.05 in non-PSL (p=0.04); 22.58 in MZL and 31.34 in non-MZL (p=0.15). The mean ISI for the whole series was 6.07 (SD +5.29; range 0.1-21.3). It was 5.23 in PSL and 7.62 in non-PSL (p=0.1); 5.70 in MZL and 6.58 in non-MZL (p=0.56). In PSL, ISI quantity was greater in MZL (5.83) than in non-MZL (2.83) (p=0.1), and a direct correlation was found between the weight of the spleen and ITOT (r=0.41, p=0.04), but not ISI quantity (r=0.04, p=0.84). Conclusions. The intrasinusoidal pattern of BM invasion is particularly frequent in MZL and PSL [1], but not specific. Moreover, ISI quantity is not indicative of splenic MZL. Therefore, the hypothesis of splenic MZL, based on the presence or quantity of ISI on bone marrow biopsy, should be supported by a complete immunophenotyping and cytogenetic analysis of the bone marrow infiltrate. 1) Franco V et al. Blood 2003; 101:2464-2472 2) Costes V et a. Br J Haematol 2002; 119:916-922
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
