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bone marrow.pptx
- 1. BONE MARROW BIOPSYIN HEMATOLOGICAL MALIGNANCIES DR SHIVAM SUBUDHI MODERATOR-DR RANJAN KUMAR MALLICK
- 2. INTRODUCTION Bone marrowexamination helps in diagnosis and management of haematological diseases. Complete marrow assessment entails two separate investigation Bone marrow aspiration- • Cell morphology • Differential count Bone marrow biopsy- • Cellularity • Fibrosis • Infiltrative disease
- 3. Indications of biopsy To accurately assess marrow cellularity Suspected focal lesions To diagnose aplastic anemia, hypoplastic MDS, hypoplastic acute leukemia Investigation and prognostication of MPN Diagnosis and staging of Hodgkins, non hodgkins lymphoma,mets Unexplained leucoerythroblastic blood picture PUO
- 4. Multiple myeloma Primary amyloidosis For IHC studies Stromal changes • Fibrosis • Necrosis • Gelatinous marrow transformation
- 6. Criteria for adequacy Length- 1.5 -2 cm 5- 6 trabecular spaces Section thickness 4 micron
- 7. Cellularity 90-100% ininfants 50-60% in adults 20-30% in old age
- 8. Normal topography Myeloid-paratrabecular, mature cells towards centre Erythroid –centre in colonies Megakaryocytes- centre around sinusoids Lymphoid precursers- periarteriolar region Stroma- fat cell, fibroblast, reticulin fibres
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- 11. AML M0 Blastsresemble L2 lymphoblasts blasts are MPO negative
- 12. AML M1 Blasts>90% Mature cells <10% >3% blasts are MPO positive
- 13. AML M2 Mostfrequent cytogenetic abnormality- t(8;21) Blasts 20- 89% of non erythroid MNCs Maturing component >10%
- 14. AML M3 Blastmay be <20% Molecular – PML RARA /t(15;17) 2 types – hypergranular variant, microgranular variant
- 15. AML M4 Blast>20% Monocytic component> 20% of non erythroid MNCs Monocytes in blood>5x103 μl
- 16. BMA BMB AML M4Eo inv (16) Eosinophilic precursers >5%
- 17. AML M5 Extramedullaryinfiltration into skin, gum, meninges, lungs AML M5a- monoblast >80% of monocytic component AML M5b- monoblast <80% Acute monocytic leukemia- NPM1 mutation
- 18. BMB AML M5aBMB- CD64 in AML M5a and M5b
- 19. AML M6 3-4% of AML Associated with profound anemia 3 sub types BMA PAS BMB
- 20. AML M7 Drytap / diluted marrow aspirate Megakaryoblastic hyperplasia with extensive fibrosis Megakaryocytic cells seen in all stages Associated with t (1;22), down syndrome
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- 22. APMF Trilineage hyperplasiawith blasts >20% Marrow fibrosis Pancytopenia Doesn't meet the criteria for AML with MDS
- 23. ALL Sub typesof ALL(FAB)- L1- small homogenous blasts L2- large heterogenous blasts L3 – large homogenous blasts BMA ALL L1 BMA ALL L2
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- 25. ALL BMB CD 19AND PAX 5
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- 31. GRANULOPOIESIS INMDS ALIP
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- 36. MDS RS SLDMDS RS MLD PS BMA PERLS’ STAIN BMA BMA
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- 39. HYPOPLASTIC MDS BMB MDS WITHFIBROSIS
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- 41. MPN WHO2016 1. CML,BCR-ABL1 positive 2. CNL 3. PV 4. PMF 5. ET 6. Chronic eosinophilic leukemia, NOS 7. MPN , unclassifiable 8. Mastocytosis
- 42. CML chronic phase PBS- TLC (30-500x103/μl), myelocytic bulge,absolute basophilia, thrombocytosis NAP score (0-20) BM-hypercellular, M:E ratio elevated, blast<5%, megakaryocyte hyperplasia with dwarf forms seen BMA
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- 44. CML Accelerated phase Blasts 10-19% Persistent thrombocytosis or thrombocytopenia Basophilia >20% Blast crisis Blast>20% Anemia and thrombocytopenia 25% cases- lymphoblastic Accelerated phase Blast crisis
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- 47. POST PVMYELOFIBROSIS
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- 52. FIBROTIC PHASE- specialstains OSTEOMYELOSCLEROSIS
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- 54. Non Hodgkin’s lymphoma Patterns of marrow involvement Packed / diffuse Nodular Paratrabecular Interstitial Mixed Intra sinusoidal
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- 56. Mantle cell lymphoma Difffuse marrow invovment Paratrabecular arrangement Variants- blastoid, lymphocytic, pleomorphic
- 57. Hairy cell leukemia PBS- pancytopenia ,hair like projections on lymphoid cells TRAP positive Splenomegaly BRAFV600E mutation BM- dry tap, focal/ interstitial / diffuse replacement of marrow by hairy cells
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- 60. Hodgkin’s lymphoma Bminvolvement – stage IV Rarely involves BM BM- hyper cellular due to myeloid hyperplasia RS cells
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- 63. SUMMARY Bone marrowbiopsy helps in diagnosis, staging and predicting prognosis of different hematological malignancies It should be ideally reported along with bone marrow aspiration and peripheral smear Clinical history, laboratory investigations , imaging information, all should be taken into consideration before any diagnosis
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