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Jeong, Chang, Lee, Hong, Hong, and Lee: Incidence and Histologic Patterns of Bone Marrow Involvement of Malignant Lymphoma Based on the World Health Organization Classification- A Single Institution Study
Original Article

Korean J Leg Med 2007;27(6):383-387.

Published online: 14 February 2007

DOI: https://doi.org/10.3343/kjlm.2007.27.6.383

Incidence and Histologic Patterns of Bone Marrow Involvement of Malignant Lymphoma Based on the World Health Organization Classification- A Single Institution Study

So Youn Jeong, M.D.1, Yoon Hwan Chang, M.D.1, Jin Kyung Lee, M.D.1, Young Joon Hong, M.D.1, Seok Il Hong, M.D.1, Seung Sook Lee, M.D.2

1Department of Laboratory Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

2Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

Received 19 June 20079 October 2007       Accepted 12 October 2007

Copyright © 2007 by the Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Working Formulation and Revised European American Classification of Lymphoid Neoplasms (REAL) have mainly been used in the studies for bone marrow involvement of malignant lymphoma in Korea. We investigated the incidence and histologic patterns of malignant lymphoma according to the WHO classification.

Methods

This study included 507 cases of malignant lymphoma that were requested for bone marrow study for the staging during the period January 1999-December 2005 in Korea Cancer Center Hospital. Medical records, peripheral blood smears, bone marrow aspiration smears, biopsy sections, and histopathologic findings were analyzed retrospectively.

Results

Of the 507 cases of malignant lymphoma, 473 (93.3%) were non-Hodgkin lymphoma (NHL) and 34 (6.7%) were Hodgkin lymphoma (HL). The overall incidence of bone marrow involvement by NHL and HL was 12.5% (59/473) and 11.8% (4/34), respectively. Among NHL cases, the incidence of bone marrow involvement by B-cell and T-cell neoplasms was 11.4% (43/377) and 16.7% (16/96), respectively. Although the incidences of bone marrow involvement by several B-cell neoplasms were more than 30%, diffuse large B cell lymphoma showed a relatively low incidence of bone marrow involvement (4.6%). Of bone marrow involvement patterns, diffuse infiltration pattern was the most common (40.0%). Peripheral blood involvement by lymphoma was observed in 35.6% of cases with bone marrow involvement.

Conclusions

We used WHO classification in the study for the bone marrow involvement of malignant lymphoma, and this single-institution study should give a useful, up-to-date histopathologic information.

Keywords: WHO classification, Malignant lymphoma, Bone marrow involvement

REFERENCES

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Table 1.
Incidence and patterns of bone marrow involvement of non-Hodgkin lymphoma
Subtype (WHO classification) N (%) N of cases with BM involvement (%) N of cases with identifiable BM involvement pattern Pattern (%)
D P N I
T-cell neoplasm              
 NK/T cell lymphoma, nasal type 31 (6.6) 1 (3.2) 1 0 (0) 1 (100) 0 (0) 0 (0)
 ALCL 22 (4.7) 3 (13.6) 3 3 (100) 0 (0) 0 (0) 0 (0)
 T-lymphoblastic lymphoma 16 (3.4) 9 (56.3) 9 4 (44.4) 2 (22.2) 0 (0) 3 (33.3)
 PTL, unspecified 15 (3.2) 0 (0) 0        
 AILT 10 (2.1) 3 (30.0) 1 0 (0) 0 (0) 0 (0) 1 (33.3)
 Blastic NK-cell lymphoma 2 (0.4) 0 (0) 0        
 T-cell total 96 (20.3) 16 (16.7) 14 7 (50.0) 3 (21.4) 0 (0) 4 (28.6)
B-cell neoplasm              
 DLBCL 281 (59.4) 13 (4.6) 12 2 (15.4) 7 (53.8) 0 (0) 3 (23.1)
 MALT lymphoma 28 (5.9) 2 (7.1) 2 0 (0) 1 (50.0) 1 (50.0) 0 (0)
 Burkitt lymphoma 21 (4.4) 7 (33.3) 6 4 (57.1) 1 (14.3) 0 (0) 1 (14.3)
 FL 20 (4.2) 6 (30.0) 6 2 (33.3) 1 (16.7) 2 (33.3) 1 (16.7)
 MCL 11 (2.3) 5 (45.5) 5 1 (20.0) 3 (60.0) 0 (0) 1 (20.0)
 SLL 8 (1.7) 6 (75.0) 6 4 (66.7) 1 (16.7) 0 (0) 1 (16.7)
 Lymphoplasmacytic lymphoma 2 (0.4) 1 (50.0) 1 1 (100) 0 (0) 0 (0) 0 (0)
 B-lymphoblastic lymphoma 2 (0.4) 2 (100) 2 1 (50.0) 1 (50.0) 0 (0) 0 (0)
 Mediastinal large B cell lymphoma 1 (0.2) 0 (0) 0        
 NMZL 3 (0.6) 1 (33.3) 1 0 (0) 1 (100) 0 (0) 0 (0)
 B-cell total 377 (79.7) 43 (11.4) 41 15 (36.6) 16 (39.0) 3 (7.3) 7 (17.1)
Total 473 59 (12.5) 55 22 (40.0) 19 (34.5) 3 (5.5) 11 (20.0)

Abbreviations: BM, bone marrow; D, diffuse; P, paratrabecular; N, nodular; I, interstitial; ALCL, anaplastic large cell lymphoma; PTL, peripheral T-cell lymphoma; AILT, angioimmunoblastic T-cell lymphoma; DLBCL, diffuse large B-cell lymphoma; MALT, mucosa-associated lymphoid tissue; FL, follicular lymphoma; MCL, mantle cell lymphoma; SLL, small lymphocytic lymphoma; NMZL, nodal marginal zone B-cell lymphoma.

Table 2.
Incidence of bone marrow involvement of Hodgkin lymphoma
Subtype N of cases (%) N of cases with bone marrow involvement (%)
Classical HL    
 Nodular sclerosis classical HL 16 (47.1) 2 (12.5)
 Mixed cellularity classical HL 10 (29.4) 1 (10.0)
 Lymphocyte-rich classical HL 3 (8.8) 0 (0.0)
 Nodular lymphocyte predominant HL 3 (8.8) 1 (33.3)
 Unclassified 2 (5.9) 0 (0.0)
Total 34 4 (11.8)

Abbreviation: HL, Hodgkin lymphoma.

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