Primary bone marrow lymphoma: An uncommon extranodal presentation of aggressive non-hodgkin lymphomas

Antonio Martinez, Maurilio Ponzoni, Claudio Agostinelli, Konnie M. Hebeda, Estella Matutes, Jacopo Peccatori, Cristina Campidelli, Blanca Espinet, Granada Perea, Agustin Acevedo, Ali Zare Mehrjardi, Monica Martinez-Bernal, Marta Gelemur, Emanuele Zucca, Stefano Pileri, Elias Campo, Armando López-Guillermo, Maria Rozman

Research output: Contribution to journalArticlepeer-review


Bone marrow involvement by lymphoma is considered a systemic dissemination of the disease arising elsewhere, although some tumors may arise primarily in the bone marrow microenvironment. Primary bone marrow lymphoma (PBML) is a rare entity whose real boundaries and clinicobiological significance are not well defined. Criteria to diagnose PBML encompass isolated bone marrow infiltration, with no evidence of nodal or extranodal involvement, including the bone, and the exclusion of leukemia/lymphomas that are considered to primarily involve the bone marrow. Twenty-one out of 40 lymphomas retrospectively reviewed by the International Extranodal Lymphoma Study Group from 12 institutions in 7 different countries over a 25-year period fulfilled the inclusion criteria. These cases comprised 4 follicular lymphomas (FLs), 15 diffuse large B-cell lymphomas (DLBCLs), and 2 peripheral T-cell lymphomas, not otherwise specified. The FL cases showed paratrabecular infiltration, BCL2 protein and CD10 expression, and BCL2 gene rearrangement. DLBCL showed nodular infiltration in 6 cases and was diffuse in 9 cases; it also showed positivity for BCL2 protein (9/10) and IRF4 (6/8). Median age was 65 years with male predominance. All but 3 FL patients were symptomatic. Most cases presented with cytopenias and high lactate dehydrogenase. Four patients (3 FL cases and 1 DLBCL case) had leukemic involvement. Most DLBCL patients received CHOP-like or R-CHOP-like regimens. The outcome was unfavorable, with a median overall survival of 1.8 years. In conclusion, PBML is a very uncommon lymphoma with particular clinical features and heterogenous histology. Its recognition is important to establish accurate diagnosis and adequate therapy.

Original languageEnglish
Pages (from-to)296-304
Number of pages9
JournalAmerican Journal of Surgical Pathology
Issue number2
Publication statusPublished - Feb 2012


  • Aggressive non-Hodgkin lymphoma
  • B-NHL
  • Bone lymphoma
  • Bone marrow
  • Diffuse large B-cell lymphoma
  • Extranodal lymphoma
  • Follicular lymphoma
  • Peripheral T-cell lymphoma

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery
  • Medicine(all)


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