Original articleGranulomatous lesions in bone marrow: Clinicopathologic findings and significance in a study of 48 cases
Introduction
Epithelioid granulomas are an infrequent finding in bone marrow biopsies and may be associated with a broad spectrum of disorders. The incidence of bone marrow granulomas ranges from 0.3% to 2.2% depending on the main series. Their significance has been a subject of interest in the past, and five large series from 1956 to 1988 have documented the incidence and aetiology of marrow granulomas [1], [2], [3], [4], [5]. Since the last review of the literature by Eid in 1996 [6], only one small Indian study on this topic has appeared in the English literature [7]. Moreover, previous studies did not distinguish granulomas found on bone marrow biopsy for staging a known pathology (i.e., lymphoma, disseminated tuberculosis) from granulomas found on biopsies for diagnosis. Accordingly, we have chosen in this work to retain only the diagnostic cases. During the past 15 years, progress has been made in diagnosing many of the diseases implicated in the pathogenesis of bone marrow granuloma using, for example, 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG-PET) and molecular biology. This study aimed to reevaluate the prevalence and aetiology of bone marrow granuloma and to evaluate the performance of these new diagnostic tools.
Section snippets
Material and methods
A retrospective case review was performed on bone marrow biopsies collected from the files of the haematology laboratory of the University Hospital Lyon, France. The records of all cases of bone marrow granulomas reported from May 2004 to July 2010 were obtained from this centre and reviewed by the same pathologist (MF) to confirm the presence of granulomas.
Bone marrow biopsies were performed by puncture of the posterior iliac crest using a Jamshidi needle. Undecalcified bone specimens were
Incidence of bone marrow granulomas
Over the six-year period of this study, 9641 bone marrow biopsies were referred to the laboratory of haematology. 57 samples revealed granulomatous lesions. This corresponds to an incidence of 0.59 per 100 biopsies and an annual rate of 9.5 cases per year.
Biopsy indication
Indications for bone marrow examination could be divided into two major categories: (i) determination of the aetiology of a specific finding in 48 patients (84.2%) and (ii) staging a known pathology in nine patients (lymphoma, n = 3;
Discussion
Bone marrow epithelioid granuloma is not a frequent finding in a bone marrow biopsy [1], [2], [3], [4], [5]. We have provided a more recent overview of the literature and assessed the value of new diagnostic tools such as FDG-PET and molecular biology.
Conclusion
The incidence of granulomatous bone marrow disease remains low, and its main aetiologies are the same as they were fifteen years ago, when the most recent case series were published. One previously unpublished entity is described: infection with B. henselae confirmed with molecular biology from node and skin biopsy in two renal transplant patients. We provide the first report of a favourable long-term course and prognosis of isolated granulomatous bone marrow disease. The percentage of
Learning points
- •
Incidence of granulomatous lesions in bone marrow is low.
- •
Most of them are associated with infectious disease.
- •
Granulomatous lesions from unknown origin have a favourable long term course and prognosis.
- •
PET-CT can be helpful in some cases and molecular biology is useful for detecting infection in immunocompromised patients.
Conflict of interests
None of the authors have conflict of interest in this article.
Acknowledgements
We thank Pr J. Ninet (Department of Internal medicine, Hôpital Edouard-Herriot, Lyon, France), Pr D. Peyramon (Department of Infectious and Tropical Diseases, Hôpital de la Croix-Rousse, Lyon, France), Pr I. Durieu (Department of Internal medicine, Hôpital Lyon Sud, Lyon, France), Pr B. Coiffier (Department of Hematology, Hôpital Lyon Sud, Lyon, France), Pr M. Michallet (Department of Hematology, Hôpital Edouard-Herriot, Lyon, France), Dr P. Bachet (Department of internal medicine, Hôpital St
References1 (36)
Granulomatous lesions in bone marrow
Blood
(1956)- et al.
Sarcoidosis
Lancet
(2003) - et al.
Fever of unknown origin in HIV/AIDS patients
Infect Dis Clin North Am
(2007) - et al.
Re-evaluation of bone marrow aspiration in the diagnosis of miliary tuberculosis
Chest
(1994) - et al.
Disseminated “Mycobacterium genavense” infection in patients with AIDS
Lancet
(1992) - et al.
Bone marrow biopsies in patients with the acquired immunodeficiency syndrome
Hum Pathol
(1984) - et al.
Sarcoid reactions in cystic duct carcinoma
Chest
(1994) - et al.
Bone marrow in malignant lymphoma
Hematol Oncol Clin North Am
(1988) - et al.
Sarcoidosis and sarcoid reactions in cancer
Rev Med Interne
(2008) - et al.
Role of fluorodeoxyglucose positron emission tomography in the diagnosis of neurosarcoidosis
J Neurol Sci
(2002)
Use of positron emission tomography in sarcoidosis
Rev Med Interne
Granulomatous bone marrow disease in Virginia: study of 50 cases
Va Med
Granulomatous bone marrow disease. A review of the literature and clinicopathologic analysis of 58 cases
Medicine
Significance of granulomas in bone marrow: a study of 40 cases
Eur J Haematol
Bone marrow granulomas: clinicopathologic findings in 72 cases and review of the literature
Hematol Pathol
Differential diagnoses of bone marrow granuloma
West J Med
Granulomas in bone marrow — a study of fourteen cases
Indian J Pathol Microbiol
ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders
Sarcoidosis Vasc Diffuse Lung Dis
Cited by (21)
Hematologic and Oncologic Aspects of Sarcoidosis: Some of the Least Studied but Most Common Dilemmas
2024, Clinics in Chest MedicineA case of bone marrow involvement in sarcoidosis with crescentic glomerular lesions
2020, Respiratory Medicine Case ReportsCitation Excerpt :Although hepatic involvement is thought to occur in 50–90% of sarcoidosis patients [3], renal involvement is only observed in approximately 4–22% of cases [4]. Bone marrow involvement in sarcoidosis is also rare [5,6] (see Table 1). We report on a 63-year-old Japanese man who presented with general fatigue, weight loss, pancytopenia, liver dysfunction and renal impairment.
Nuclear Imaging in Sarcoidosis
2018, Seminars in Nuclear MedicineCitation Excerpt :Bone marrow sarcoidosis is associated with higher incidences of extrapulmonary involvement, leucopenia, lymphopenia, and anemia and hypercalcemia.89,95,96 In a series of 9641 bone marrow biopsies, Brackers de Hugo et al97 identified 49 samples with granulomas. Infection was the most common (33%), followed by sarcoidosis (21%), malignancy (19%), and therapy-induced granulomas (6%).
Benign Causes of Bone Marrow Abnormalities Including Infections, Storage Diseases, Systemic Disorders, and Stromal Changes
2018, Hematopathology: A Volume in the Series: Foundations in Diagnostic PathologyMycobacterial bone marrow infections at a medical centre in Taiwan, 2001-2009
2014, Epidemiology and Infection
- 1
This work has been presented as an oral communication at the 63rd Congress of the Société Nationale Française de Médecine Interne (SNFMI) in Poitier, France on June 9th, 2011.