BONE MARROW IN PEDIATRIC PATIENTS WITH HODGKIN’S DISEASE

Fauzia Shafi Khan, Rabiya Fayyaz Hasan

Abstract


Background: Hodgkin’s disease is a malignant process of lymphoreticular system that constitutes
6% of childhood cancers Accurate staging of lymphoma is the basis for rational therapeutic planning
and assessment of the presence or absence of marrow involvement is a basic part of the staging
evaluation. The objective of this study was to determine the incidence of marrow infiltration in
paediatric patients with Hodgkin’s disease and to ascertain its morphological spectrum in the
marrow. Methods: The study included 85 paediatric patients with diagnosed Hodgkin’s disease seen
at The Children’s Hospital/Institute of Child Health, Lahore, from January 2010 to December 2011,
referred to haematology department for bone marrow biopsies. Results: Ages ranged between two
years to fourteen years with an average age of seven years, the male female ratio being 13:1. Mixed
cellularity was the commonest histological type present in 66 (78%) cases. The presenting feature
common in all cases was superficial lymphadenopathy followed by hepatomegaly in 17 (20%) cases
and splenomegaly in 16 (19%). All the marrow aspirates were negative for infiltration, Trephine
biopsies revealed marrow infiltration in 9 (10.5%). Five (56%) cases had bilateral while 4 (44%) had
unilateral involvement. Pattern of infiltration was diffuse in 8 (89%) and focal in one (11%)
trephines. Increased marrow fibrosis was present in eight (89%) cases. Diagnostic Reed Sternberg
cells were identified in only one case and the mononuclear variants were present in six cases and
atypical cells were present in two cases in these immunohistochemistry for CD15 and CD30 was
performed which was positive. Granulomas in one and lymphoid aggregates were present in two
trephine biopsies otherwise negative for Hodgkin’s infiltration. Conclusion: Bone marrow
infiltration was present in 10.5% cases, immunohistochemistry was used to confirm infiltration in
two cases, the pattern of infiltration being diffuse in majority (89%).
Keywords: Hodgkin’s Disease, Bone marrow biopsy

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