TY - JOUR
T1 - Primary bone marrow lymphoma
T2 - An uncommon extranodal presentation of aggressive non-hodgkin lymphomas
AU - Martinez, Antonio
AU - Ponzoni, Maurilio
AU - Agostinelli, Claudio
AU - Hebeda, Konnie M.
AU - Matutes, Estella
AU - Peccatori, Jacopo
AU - Campidelli, Cristina
AU - Espinet, Blanca
AU - Perea, Granada
AU - Acevedo, Agustin
AU - Mehrjardi, Ali Zare
AU - Martinez-Bernal, Monica
AU - Gelemur, Marta
AU - Zucca, Emanuele
AU - Pileri, Stefano
AU - Campo, Elias
AU - López-Guillermo, Armando
AU - Rozman, Maria
PY - 2012/2
Y1 - 2012/2
N2 - 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.
AB - 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.
KW - Aggressive non-Hodgkin lymphoma
KW - B-NHL
KW - Bone lymphoma
KW - Bone marrow
KW - Diffuse large B-cell lymphoma
KW - Extranodal lymphoma
KW - Follicular lymphoma
KW - Peripheral T-cell lymphoma
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UR - http://www.scopus.com/inward/citedby.url?scp=84857776585&partnerID=8YFLogxK
U2 - 10.1097/PAS.0b013e31823ea106
DO - 10.1097/PAS.0b013e31823ea106
M3 - Article
C2 - 22251943
AN - SCOPUS:84857776585
VL - 36
SP - 296
EP - 304
JO - American Journal of Surgical Pathology
JF - American Journal of Surgical Pathology
SN - 0147-5185
IS - 2
ER -