• Umar Zahur
  • Lubna Zafar
  • Sehar Khaliq
  • Madeeha Rehan
  • Attika Khalid


Background: Non-Hodgkin lymphoma (NHLs) are a heterogeneous group of lymphoid neoplasms, characterized by an irregular pattern of spread and may present with extranodal involvement This study was conducted to determine the frequency and pattern of Bone marrow involvement on trephine biopsy in cases of Non-Hodgkin lymphoma (NHL). Methods: This cross sectional study was conducted in Pathology department of Fauji Foundation Hospital (FFH)/Foundation University medical college (FUMC) Rawalpindi, from14th December 2010 to 14th December 2011. One hundred and six patients with histopathologically confirmed Non-Hodgkin lymphoma on lymph node (LN) biopsy, who had not received any chemotherapy were selected and Bone Marrow (BM) trephine biopsies for staging were performed on them. Results: Out of one hundred and six patients, forty five (42.5%) were diagnosed to have Bone Marrow involvement on staging. The most common pattern was diffuse, i.e., 44.44%, followed by the interstitial infiltrate in 28.89%, focal and mixed constituted 11.11% each, and paratrabecular pattern was found in 4.44%. Conclusion: This study highlights the high incidence of involvement and diffuse pattern in the Bone marrow biopsies of newly diagnosed Non-Hodgkin lymphoma, both of which indicate poor prognosis. Keywords: Non-Hodgkin lymphoma; bone marrow; prognosis; staging


Hingorjo MR, Syed S. Presentation, staging and diagnosis of lymphoma: a clinical perspective. J Ayub Med Coll Abbottabad 2008;20(4):100–3.

Hoffbrand AV, Moss PAH. Non-Hodgkin lymphoma. In: Hoffbrand AV, Moss PAH, editirs. Essential Hematology. 6th edn. Oxford, UK: Wiley- Blackwell publications; 2011.p.253–71.

Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer Stastistics, 2003. CA Cancer J Clin 2003;53:5–26.

Alexander DD, Mink PJ, Adami HO, Chang ET, Cole P, Mandel JS, et al. The non-Hodgkin lymphomas: a review of the epidemiologic literature. Int J Cancer 2007;120:1–39.

El Bolkainy TM, Abo Deif WS, Gouda HM, Mokhtar NM. Evaluation of bone marrow in 143 lymphomas: the relative frequency and pattern of involvement, secondary myelopathies, pitfalls and diagnostic validity. J Egypt Natl Canc Inst 2008;20(1):17–30.

Kumar S, Rau AR, Naik R, Kini H, Mathai AM, Pai MR, et al. Bone marrow biopsy in non-Hodgkin lymphoma: A morphological study. Indian J Pathol Microbiol 2009;52(3):332–8.

Hamid GA, Hanbala N. Comparison of bone marrow aspiration and bone marrow biopsy in neoplastic diseases. Gulf J Oncolog 2009;6:41–4.

Pervez S, Nasir MI, Moatter T, Ahsan A, Haq A, Siddiqui T. Characterization of genetic lesions in apoptosis-regulating and proliferation control genes in diffuse large B-cell non-Hodgkin's lymphoma. J Cancer Res Ther 2009;5:254–62.

Cancer Registry and Clinical Data Management (CRCDM) .Annual Cancer Registry Report 2008.[Internet]. Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC) [cited 2013 Jan 15]. Available from

Arber DA, George TI. Bone marrow biopsy involvement by non-Hodgkin’s lymphoma: frequency of lymphoma types, patterns, blood involvement, and discordance with other sites in 450 specimens. Am J Surg Pathol 2005;29(12):1549–57.

Jeong SY, Chang YH, Lee JK, Hong YJ, Hong SI, Lee SS. Incidence and histologic patterns of bone marrow involvement of malignant lymphoma based on the World Health Organization classification: a single institution study. Korean J Lab Med 2007;27(6):383–7.

Bishop PW, McNally K, Harris M. Audit of bone marrow trephines. J Clin Pathol 1992;45(12):1105–8.

Bain BJ, Clark DM, Wilkins BS, editors. Bone marrow pathology. 4th edn. Oxford, UK: Wiley Blackwell Publications; 2010.

Butt F, Akhtar R, Rahmani T, Waheed A, Aman S, Hamid S. Bone Marrow Involvement in Lymphomas: Incidence and Co-relation with age and sex. Biomedica 2002;18:53–7.

Zhang QY, Foucar K. Bone marrow involvement by hodgkin and non-hodgkin Lymphomas. Hematol Oncol Clin North Am 2009;23(4):873–902.

Lee WI, Lee JH, Kim IS, Lee KN, Kim SH. Bone marrow involvement by non- Hodgkin's lymphoma. J Korean Med Sci 1994;9(5):402–8.

Hoffbrand AV, Catovsky D, Tuddenham EGD, Green AR, editors. Postgraduate Hematology. 6th ed. Oxford, UK: Wiley-Blackwell publications; 2011.

Fisher RI, Mauch PM, Harris NL, Friedberg JW. Non-Hodgkin’s lymphoma. In: Devita VT, Hellman S, Rosenberg SA, editors. Principles & Practice of Oncology. 7th ed. Philadelphia, USA: Lippincott William’s and Wilkins; 2005. p. 1957–2075.

Zinzani PL. Lymphoma: diagnosis, staging, natural history, and treatment strategies. Semin Oncol 2005;32(1 Suppl 1):S4–10.