Interpretation of Bone Marrow Trephine Biopsies in Hematological Disorders with Special Emphasis on Morphological Patterns in Lymphomas

Context: Hematological disorders are seen in all age groups. Bone marrow trephine biopsy plays a major role in the diagnosis of underlying causes, in addition to staging and follow-up of hematological malignancies. Aims: To study the trephine biopsies received in the department of clinical pathology with respect to age and sex incidence, to correlate with bone marrow aspirations, with special emphasis to its importance in cases where bone marrow aspiration yields a dry tap. Settings and Design: 105 cases of bone marrow trephine biopsies performed in our institution over a period of one and a half years are included in the study. Methods and Materials: A prospective study of 105 cases of bone marrow trephine biopsies was conducted. The biopsies were fixed in 10% buffered formalin solution and decalcified using 5% concentrated nitric acid for 4-6 hours, followed by routine processing. Serial sections were stained with Hematoxylin and Eosin (H and E), reticulin stains and Immunohistochemical markers in some. Results: The majority of bone marrow biopsies showed reactive marrows (42 cases) followed by normal marrows (12 cases) and hypoplastic marrows (5 cases). Bone marrow biopsy showed involvement by leukemias in 11 cases(10.5%), lymphomas in 8 cases (7.6%),Myeloma in 6 cases(5.7%)and secondary deposits in 2 cases (1.9%). There were 5 cases of Megaloblastic anemia(4.8%), four cases of myelofibrosis (3.8%), two cases of idiopathic thrombocytopenic purpura (ITP)(1.9%) and one case each of aplastic anemia and autoimmune hemolytic anemia(0.9%). Out of 8 cases of Non Hodgkin’s lymphomas - 3(37.5%) showed nodular, 2 diffuse(25%), 1(12.5%) interstitial pattern, 1 interstitial diffuse(12.5%) and 1 para trabecular pattern(12.5%) of marrow infiltration on trephine biopsy section. Nodular, interstitial and para trabecular patterns had good prognosis. Interstitial diffuse had intermediate prognosis and diffuse pattern had bad prognosis. There were 28 cases of dry tap in bone marrow aspiration and biopsy provided the clue in 18 cases. 5 cases in which bone marrow aspiration revealed a normal marrow study yielded a definitive diagnosis in bone marrow biopsies.3 of them were lymphomas (NHL) with nodular pattern and two were metastatic deposits. Conclusions: Examination of bone marrow biopsies increased diagnostic accuracy, hence contributing to prognosis especially in lymphomas and definitive targeted therapy. Only a biopsy provided a complete assessment of marrow architecture and pattern of distribution in case o