[Reactive lymphoid nodule or malignant lymphoma. A brief guideline for the differential diagnosis of bone marrow infiltrates in non-Hodgkin lymphomas].
Differentiation of focal or extended lymphoid bone marrow infiltrates presents a diagnostic challenge and therefore warrants systematic evaluation of those features which affect this. One of the basic requirements is an appropriate technique of processing the bone marrow specimens. This includes the possibility of enzyme evaluation (naphthol-AS-D-chloroacetate esterase) and immunohistochemistry (set of monoclonal antibodies) and comparison with the corresponding lymph node histology. A number of histological parameters have emerged with a distinctive property for distinguishing between reactive focal lymphoid aggregates and malignant lymphomas. Amongst these the pattern of infiltrates, i.e., histotopography (subcortical infiltrates, paratrabcular-endosteal localization, margination, tandem-like extension between adipocytes and cribriform appearance), content of reticulin fibers, cytology (small lymphocytes versus large blast cells) and, finally, immunohistochemistry (monoclonal versus polyclonal expression of cytoplasmic immunoglobulins, uniform versus mixed population of B or T lymphocytes) are most important. In conclusion, synoptic consideration of several parameters, in particular histotopography and immunohistochemistry provides a most promising approach to differentiate neoplastic from reactive lymphoid lesions in the bone marrow.
Thiele
J
J
Zentrum für Pathologie der Universität zu Köln.
Kvasnicka
H M
HM
D000917:Antibody Formation; D015703:Antigens, CD / Q000032:analysis; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology; D001854:Bone Marrow Cells / Q000473:pathology*; D003937:Diagnosis, Differential; D017408:Guidelines as Topic; D006801:Humans; D008198:Lymph Nodes / Q000276:immunology / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology; D008223:Lymphoma / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000473:pathology*; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology
D015703:Antigens, CD