Bone Marrow Diagnosis

An Illustrated Guide

Kevin Gatter, David Brown

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118952047
• Edition: 3
• Topic: Medicine
• Subtopic: Pathology

Bone Marrow Diagnosis, Third Edition, is an essential resource for pathologists and haematologists who need to report bone marrow trephine biopsies.

Practical and highly illustrated this edition has been comprehensively updated whilst remaining succinct and concentrating on the core information necessary to make an accurate diagnosis.

The text provides comparisons of the common methods of sample collection, fixation and staining, and a clear description of how to examine a trephine section. Applying a consistent approach, the chapters cover the range of disorders of bone marrow, discussing the clinical features, histopathology of bone marrow and diagnostic problems of each condition. Each chapter closes with a summary of key points and each diagnostic entity is accompanied by high quality images, over 900 in all, showing typical and more unusual examples of histological features.

This compact text, oriented at diagnosis and comprehensively accompanied by usable illustrations, is an invaluable reference tool for the trainee and practicing histopathologists, pathologists and haematologists.

• A practical guide aimed at allowing a busy pathologist to easily find the essential description and illustration of the most common bone marrow diseases seen in trephines
• Covers new treatment for chronic myeloid leukaemia, B-cell lymphoma and antibody treatments
• High quality colour images accompany each diagnostic entity
• Coverage of cytology in sections relating to myeloid dysplasias and acute leukaemias
• Addresses lymphoma categorization and individual lymphoma entities
• Incorporates new WHO classifications of lymphomas and leukaemias

CHAPTER 1
Introduction

During the late 1950s, McFarland and Dameshek introduced an acceptable means of obtaining bone marrow core biopsies.¹ This advance made it possible for the histopathologist to diagnose a wide range of haematopathological disorders including the leukaemias, lymphoproliferative and myeloproliferative disease, myelodysplasia, metastases and reactive disorders.

Most biopsies are taken from the posterior superior iliac spine. Ideally in an adult the core of tissue should be at least 1 cm in length. This often raises the question: ‘But what is the minimum you need?’ There is no standard answer. Although half a crushed marrow space full of carcinoma is diagnostic, in most cases a good rule of thumb is a minimum of five complete marrow spaces for most haematological diagnoses. An aspirate is usually taken from the same site before the biopsy is removed (but from a different needle track, or the biopsy may be a haemorrhagic mess). The haematologist will usually make about 10 smear preparations from the marrow particles that have been aspirated and either discard or send the remainder for histology. We find it useful to have both of these types of specimen since there are occasions when only an aspirate is available, in which case it is then important to have built up experience examining aspirate preparations for which trephines have been available for comparison.

The trephine biopsy has a number of advantages over the aspirate specimen. The most important is to enable examination of the topographical distribution of the cellular constituents of the marrow, their relationships to the bony trabeculae and an assessment of marrow cellularity. Furthermore, in diseases which produce fibrosis, e.g. Hodgkin lymphoma or myeloproliferative disorders, an aspirate often fails to produce an adequate diagnostic sample (‘a dry tap’).

Close liaison with haematologists is important since it makes the reporting of trephine biopsies easier and ensures that misdiagnoses are kept to a minimum. Many if not most authorities recommend reporting of the trephine biopsy alongside the aspirate, either by yourself or with the haematologist. However, this does not seem to be common practice and, as workloads and specialist referrals rise, will inevitably decline. You can report safely most trephines on their own provided you know your limitations and keep a good dialogue open with your clinicians. Multidisciplinary team meetings are also invaluable, allowing for a review of all malignant haematological diagnoses and discussion of diagnostically difficult cases. The authors appreciate that many trainee histopathologists who see only occasional trephine biopsies find it difficult to observe any order, even in a normal marrow, and often give up on this subspecialty as being ‘too difficult’. Our advice is to persist and spend time initially on examining as many normal/reactive marrows as possible.

There has been debate involving the embedding medium for bone marrow biopsies. There are essentially two schools of thought: those who believe that the biopsies should be embedded in plastic and those who believe paraffin embedding with decalcification to be superior. The reason for this divergence is related to the nature of the biopsy itself, which consists of both hard tissue (i.e. bone) and soft tissue (i.e. marrow and fat). In order to cut intact sections one can either make the biopsy material uniformly soft (by decalcification) or uniformly hard (by resin embedding).

Unfortunately, decalcification inevitably produces some tissue distortion and plastic embedding limits the range of immunohistochemical studies. The debate over which is superior continues, with vociferous advocates on either side.^2–6 The advantages and disadvantages of each approach are summarized in Table 1.1.

Table 1.1 Comparison of the relative advantages and disadvantages of paraffin and plastic embedding of bone marrow trephine biopsies.

	Paraffin embedding	Resin/plastic embedding
Advantages	Widespread antigen preservation allows immunohistochemical studies Pathologists are familiar with sections cut from paraffin-embedded material	Superb cytological detail available from the very thin sections obtained by this technique
Disadvantages	Loss of some histochemical reactivity within the granules of the granulocyte and mast cell series, e.g. Leder stain. This loss is directly proportional to the strength of t...

Table of contents

• Cover
• Table of Contents
• Title page
• Copyright page
• Preface to the Third Edition
• Preface to the First Edition
• CHAPTER 1: Introduction
• CHAPTER 2: The Normal Bone Marrow
• CHAPTER 3: Infections Including Human Immunodeficiency Virus
• CHAPTER 4: Anaemias and Aplasias
• CHAPTER 5: The Myelodysplastic Syndromes
• CHAPTER 6: Myeloproliferative Neoplasms
• CHAPTER 7: Acute Leukaemia
• CHAPTER 8: Lymphomas: an Overview
• CHAPTER 9: Precursor B and T Lymphoblastic Leukaemia (Acute Lymphoblastic Leukaemia) and Lymphoblastic Lymphoma
• CHAPTER 10: Mature B Cell Neoplasms
• CHAPTER 11: Mature T and NK Cell Neoplasms
• CHAPTER 12: Hodgkin Lymphoma
• CHAPTER 13: Metastatic Disease
• CHAPTER 14: Bone, Stroma and Miscellaneous Changes
• CHAPTER 15: Technical Considerations
• Index
• End User License Agreement