Bone marrow biopsy and interpretation
-
Upload
sofisudha -
Category
Health & Medicine
-
view
3.509 -
download
1
Transcript of Bone marrow biopsy and interpretation
![Page 1: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/1.jpg)
BONE MARROW BIOPSY AND INTERPRETATION
JULY 2016
![Page 2: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/2.jpg)
STRCTURE OF BONE MARROW
• A) cellular elements
Haematopoetic stem cells , Progenitors , precursors .
B) Stroma - unique microenvironment of the marrow
![Page 3: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/3.jpg)
BONE MARROW BIOPSY NEEDLES
• Jamshidhi
• Islam
• Westerman jensen
• Drills
• Disposable needles
![Page 4: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/4.jpg)
DRILLER
![Page 5: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/5.jpg)
INDICATIONS
• Evaluation of hematologic abnormalities in peripheral smear
• Evaluation of primary bone marrow disorder
• Staging of bone marrow involvement by metastatic tumors
• Evaluation of metabolic storage disorders
• PUO.
![Page 6: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/6.jpg)
SITES OF BONE MARROW BIOPSY
• Posterior superior iliac spine
• Anterior superior iliac spine
• Iliac crest
• Tibial tuberosity in children .
![Page 7: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/7.jpg)
![Page 8: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/8.jpg)
![Page 9: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/9.jpg)
PROCESSING OF BONE MARROW BIOPSY
1. FIXATION
10% buffered formalin
Zenkers fluid
2. DECALCIFICATION
Formic acid 6-8 hours
Nitric acid 2-3 hours
EDTA
![Page 10: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/10.jpg)
PROCESSING OF BONE MARROW BIOPSY
3.EMBEDDING
Paraffin
Resin
4. STAINING
H & E , Reticulin , Perls
Masson trichrome .
![Page 11: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/11.jpg)
BM BIOPSY EVAULATION
BASED ON
1. Clinical history
2. Physical examination findings
3. Complete hemogram
4. Peripheral blood smear
5. Aspiration
![Page 12: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/12.jpg)
BM BIOPSY EVAULATION • ADEQUACY OF BIOPSY
. Length 1.6 cm ( 1.5 –2.5cm )
.25% shrinkage during processing
.5-6 trabecular spaces
. Good quality staining
![Page 13: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/13.jpg)
Evaluation
• Cellularity
• Topography of hemopoetic cells
• Proliferation of cell lines
• Fibrosis
• Infections
• Infilterative diseases
![Page 14: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/14.jpg)
CELLULARITY
• Exact cellularity of marrow is assessed Decreases with increase in age
• Infants 80- 100%
• Adults 50 – 60 %
• Old age 20 – 30 %
• Adults - sub cortical marrow is hypoplastic
![Page 15: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/15.jpg)
![Page 16: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/16.jpg)
![Page 17: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/17.jpg)
![Page 18: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/18.jpg)
TOPOGRAPHY OF HEMOPOETIC CELLS
• MYELOID CELLS
- Paratrabecular
- mature cells towards centre
ERYTHROID CELLS
- centre in colonies
• MEGAKARYOCYTES
- Centre around sinusoids
. STROMA
fat cells , fibroblast , reticulin fibres , macrophages.
![Page 19: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/19.jpg)
![Page 20: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/20.jpg)
PROLIFERATIVE CELL LINES
• Erythroid cell line hyperplasia –megaloblastic anemia
• Myeloid hyperplasia – in CML
• Megakaryocytic proliferation in – essential thrombocythaemia
• All the three in cellular phase of primary myelofibrosis .
![Page 21: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/21.jpg)
THROMBOCYTHEMIA
![Page 22: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/22.jpg)
OTHER CELLS
• Macrophages , plasmacells , mast cells , eosinophils and lymphocytes .
• Multiple lymphoid nodules – IHC to rule out neoplastic lymphoproliferative disorder
![Page 23: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/23.jpg)
STROMAL CHANGES
• 1.Bone marrow fibrosis – indicates increase in reticulin or collagen
CAUSES• idiopathic / primary myelofibrosis• CML , MDS with fibrosis , Hodgkin deposit in
marrow , Hairy cell leukemia , metastatic deposit in marrow .
• HIV infection , hyperparathyroidism , systemic diseases like scleroderma , SLE
![Page 24: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/24.jpg)
FIBROSIS GRADING – MODIFIED BAUERMEISTER
GRADE 0 No reticulin fibres demonstrable
GRADE 1 Occasional fine individual fibres or foci of fine fibre network
GRADE 2 Fine fibre network throughout most of the marrow section , no coarse fibres
GRADE 3 Diffuse fibre network with scattered thick coarse fibres but no more collagen
GRADE 4 Diffuse , often coarse fibre network with areas of collagenisation
![Page 25: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/25.jpg)
![Page 26: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/26.jpg)
![Page 27: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/27.jpg)
2. GELATINOUS TRANSFORMATION OF BONE MARROW
• Also known as STARVATION MARROW / SEROUS ATROPHY .
• Characterised by focal or diffuse extracellular deposition of gelatinous material in between fat cells and hypocellular marrow
• CAUSES post chemotherapy , malnutrition , anorexia nervosa , HIV , chronic tuberculosis , chronic liver disease .
acid mucopolysaccharides in the gelatinous material stain with ALCIAN BLUE
![Page 28: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/28.jpg)
![Page 29: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/29.jpg)
![Page 30: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/30.jpg)
BONE MARROW NECROSIS
• Necrosis of hematopoietic cells or necrosis of neoplastic cells that have replaced normal marrow elements .
• may be associated with osteonecrosis -absence of osteoblasts lining the trabeculae & osteocytes in the lacunae
• Necrotic areas – anucleate pink ghost cells
![Page 31: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/31.jpg)
Contd…
• Degree of necrosis variable – focal , moderate or extensive
CAUSES • acute leukemia ( pre / post chemotherapy )• sickle cell anemia • CML , NHL , HODGKINS DISEASE • HIV • Q fever , histoplasmosis• metastatic deposits
![Page 32: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/32.jpg)
![Page 33: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/33.jpg)
APLASTIC ANEMIA
• Progressive pancytopenia , reticulocytopenia
• Bone marrow biopsy < 25 % of normal cellularity of that age.
![Page 34: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/34.jpg)
![Page 35: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/35.jpg)
CML
BONE MARROW • Hyper cellular• M : E 15 : 1 to 30 : 1 • Proliferation of granulocytic precursors
MEGAKARYOCYTEShyperplasia with focal clustering , Smaller and hypolobated forms Seen in sinusoids , paratrabecular zones
![Page 36: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/36.jpg)
![Page 37: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/37.jpg)
![Page 38: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/38.jpg)
MYELODYSPLASTIC SYNDROMES
• Cellularity
• Topography - ALIP
Paratrabecular megakaryocytes
• Dys poeitic features
• Blast count
• associated fibrosis
![Page 39: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/39.jpg)
HYPOCELLULAR MDS
![Page 40: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/40.jpg)
MDS associated with Fibrosis
![Page 41: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/41.jpg)
HODGKINS LYMHOMA BONEMARROW BIOPSY
• Staging
• Incidence of bonemarrow involvement 2to 30 %
• Mixed cellularity and lymphocyte depleted
• Manifested as focal or diffuse type
![Page 42: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/42.jpg)
CRITERIA FOR BM INVOLVEMENT
CERTAIN TYPICAL RS CELLS OR MONONUCLEAR VARIANTS IN CHARACTERISTIC CELLULAR ENVIRONMENT
SUGGESTIVE ATYPICAL HISTIOCYTE OR CHARACTERISTIC CELLULAR BACK GROUND
SUSPICIOUS FIBROSIS / NECROSIS ALONE .
![Page 43: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/43.jpg)
BONE MARROW IN NHL
• Staging
• Marrow involvement is more frequent in low grade NHL – modest effect on patient outcome
• Less common in high grade NHL – poor prognosis .
• Predictor of high risk for CNS involvement
![Page 44: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/44.jpg)
• Pattern of involvement
• nodular , diffuse , paratrabecular , interstitial , mixed
• IHC
• tumor cell burden
![Page 45: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/45.jpg)
![Page 46: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/46.jpg)
CLL
• Interstitial / nodular – better prognosis
• Increased fibrosis – bad prognosis
• increased plasma cells – bad prognosis
![Page 47: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/47.jpg)
HAIRY CELL LEUKEMIA
• Pancytopenia , spleenomegaly
• Bone marrow aspiration - DRY TAP
• Biopsy – diffuse / focal / nodular marrow involvement
• Cell morphology – fried egg appearance / honey comb appearance
• Web like reticulin meshwork
![Page 48: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/48.jpg)
![Page 49: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/49.jpg)
GRANULOMA
• Bacterial - TB , leprosy , syphillis , brucellosis , typhoid .
• Viral - EBV , HIV
• Rickettsia - Q fever
• Fungal – cryptococcosis , histoplasmosis
• Sarcoidosis
![Page 50: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/50.jpg)
![Page 51: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/51.jpg)
![Page 52: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/52.jpg)
METASTASIS
• Carcinoma / lymphoma
• For staging of malignancy
• Evaulate occult malignancy
Adults
ca breast, thyroid , prostate , stomach , kidney , lung .
Children
neuroblastoma , RMS, retinoblastoma , PNET , Ewings sarcoma
![Page 53: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/53.jpg)
![Page 54: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/54.jpg)
SUMMARY
EVAULATION OF BONE MARROW BIOPSY
• Adequate clinical history
• Better tissue processing
• Cellularity and topography of cellular elements , their physiological variation .
• Stromal changes – fibrosis , necrosis .
• Infections - granulomas
![Page 55: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/55.jpg)
REFERENCES
• WINTROBES CLINICAL HAEMATOLOGY 13 EDITION
• DAICIE PRACTICAL HAEMATOLOGY
• HOFFBRAND
• INTERNET
![Page 56: Bone marrow biopsy and interpretation](https://reader034.fdocuments.in/reader034/viewer/2022050613/5874d2071a28abd05f8b4a47/html5/thumbnails/56.jpg)
THANK YOU