title: Nodular pattern of bone marrow infiltration: frequent finding in immunosuppression-related EBV-associated large B-cell lymphomas.
abstract: Different patterns of bone marrow (BM) infiltration by diffuse large B cell lymphomas (DLBCL) have been described. A pure nodular pattern is uncommon, and the pathologic features, as well as the clinical correlates of DLBCL manifesting this pattern in the BM have not been well characterized. We evaluated BM biopsies involved by large B cell lymphomas diagnosed at our institute over an 11-year period to assess the morphology, phenotype, cytogenetic abnormalities, and clinical features of cases associated with a nodular pattern. A distinct nodular pattern of BM involvement was noted in 14 out of 55 (25%) cases. Although both EBV+ and EBV- DLBCL with this pattern were identified, a pure nodular pattern was significantly more common in EBV+ DLBCL compared to EBV- DLBCL (8/9, 89% versus 6/46, 13%; P = 0.00002). The majority of EBV+ DLBCL associated with a nodular pattern had distinctive morphologic features (polymorphic cellular infiltrate and pleomorphic cytology), and CD30 expression was more commonly observed in this group (P = 0.0163). All EBV+ DLBCL and two out of six (33%) EBV- DLBCL had nongerminal center phenotypes. No recurrent cytogenetic abnormalities were detected in either group. Importantly, all EBV+ DLBCL occurred in individuals with immune dysfunction (organ transplant recipients, HIV infection) or in those >50 years of age. Our study indicates a much higher predilection for EBV+ DLBCL to involve the marrow in a nodular pattern compared to EBV- cases and highlights similarities in the morphologic pattern of BM involvement by previously recognized subsets of immunodeficiency-related EBV + lymphomas and the newer entity of "EBV+ DLBCL of the elderly."
authors.affiliation: Department of Pathology, Columbia University Medical Center, New York Presbyterian Hospital, 630 W. 168th Street, New York, New York 10032, USA.
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Sevilla
authors.forename: Erin M
authors.initials: EM
authors.lastname: Weeden
authors.forename: Suzy
authors.initials: S
authors.lastname: Alexander
authors.forename: Vundavalli V
authors.initials: VV
authors.lastname: Murty
authors.forename: Bachir
authors.initials: B
authors.lastname: Alobeid
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology*; D002675:Child, Preschool; D005260:Female; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain / Q000235:genetics; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D017730:Ki-1 Antigen / Q000235:genetics; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged
chemical_list: D017730:Ki-1 Antigen