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Forum Name: Miscellaneous Cancer Topics

Question: Lymphoid Nodule in Bone Marrow Biopsy


 Delia - Sun Jan 02, 2005 11:33 am

Hello,

I need some clarification on my recent bone marrow biopsy for pancytopenia. The report states that there was a single non-paratrabecular lymphoid nodule of uncertain clinical significance found in the bone marrow core biopsy. It goes on to stat under comments "to clarify the significance of the small lympoid nodule present in the bone marrow core biopsy immunohistochemistry studies were attempted. However, the lymphoid nodule was not present in the sections cut at (name of lab).

This doesn't make any sense to me since all lab materials were sent to the same place. Should I be concerned by the lymphoid nodule? My hematologist placed me on iron capsules as the bone marrow also indicated absent iron stores despite normal blood iron and total iron binding capacity values.

Thank you very much
Delia
 Dr. Tamer Fouad - Sun Jan 02, 2005 12:10 pm

User avatar Dear Delia,
I have already answered this question in a different thread. Please keep all the posts in one thread as this makes it easier for the doctors to follow up on your question.
To explain a bit more, a lymphoid nodule occurs when there is a reaction to some immune process. Lymph cells start to aggregate and form nodules to participate in the immune reaction. This can be seen in the marrow exam as a nodule. Nodules can also form in the marrow in lymphoproliferative disorders and hematological malignancies of lymphoid origin. To differentiate the two types immunohistochemistry is performed to determine whether the cells in the nodule are monoclonal or polyclonal. Monoclonal means they all come from the same mother cell, this is common with malignancy where many cells are produced from one 'malignant' clone. Polyclonality means this is a normal immune reaction coming from many differnt clones of healthy lymph cells that have multiplied to participate in the immune reaction.

Immune reactions of this nature are nonmalignant but can be the result of several diseases: infections, allergic reactions, autoimmune diseases.

The reason why we think its probably not malignant is because malignancies of lymph system would clearly show up on routine blood count and bone marrow examination. They would not show up as pancytopenia without the presence of a very large number of malignant cells that have taken up all the healthy space in the marrow and rendered it unusable by normal cells.

If you are still concerned you may add the results of the various marrow elements expressed with their relative normal limits.

Best regards,
 Delia - Mon Jan 03, 2005 8:03 am

Good Morning Dr. Fouad,

I apologize for posting a second time and appreciate your thorough explanation. I guess I will just wait and see what the Dr. says next time I see him.

Sincerely,
Delia

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