Bone Marrow Histologic and lmmunohistochemical Findings in Peripheral T-cell Lymphoma: A Study of 38 Cases PHILIPPE GAULARD, MD, PANAGIOTIS KANAVAROS, MD, JEAN-PIERRE FARCET, MD, FRANCISCO DAR10 ROCHA MD, CORINNE HAIOUN, MD, MARINE DIVINE, MD, FELIX REYES, MD, AND ELIE SERGE ZAFRANI, MD The histologic and immunohistochemical findings in hone marrow (BM) biopsies from 38 patients with peripheral T-cell lymphoma (PTCL) are reported. Routine light microscopy showed that BM involvement was unequivocal in 12 cases and questionable in 14 cases. There was no histologic evidence of lymphoma in the remaining 12 cases. Immunohistochemistry performed on BM frozen sections demonstrated the T-cell origin of the infiltrating lymphoid cells in 24 of the 26 patients with unequivocal or questionable involvement. The malignant nature of these cells was suggested by demonstration of an aberrant T-cell phenotype identical to that observed in the other sites of involvement. In addition, in four of the 12 cases with apparently normal BM at routine liglht microscopy, immunohistochemistry revealed a minimal hut plhenotypically abnormal T-cell population, suggesting mild infiltration by lymphoma. These combined histologic and immunohktochemical data documented a high incidence (73%) of BM involvement by F’TCL. In addition, a very peculiar sinusal pattern of BM involvement was found in five patients who presented an unusual type of hepatosplenic T-cell lymphoma expressing the y6 T-cell receptor. The present study demonstrates the high incidence of BM involvement by PTCL and emphasizes the value of frozen section immunohistochemistry to establish this diagnosis, especially when routine light microscopy findings are questionable. HUM PATHOL 22:331-338. Copyright 0 1991 by W.B. Saunders Company

ject of detailed analysis in a few reports.‘“,‘” and the usefulness of immunohistochemistry of frozen BM biopsies has. to our knowledge, never been extensively investigated. The present study focuses on the histopathology of BM in 38 cases of PTCL and emphasizes the value of tumor cell immunophenotyping with a panel of monoclonal antibodies on frozen sections of BM biopsies. In addition, the diagnostic problems raised by BM involvement in PTCL are pointed out. PATIENTS AND METHODS Patients Thirty-eight present series.

patients with P’I‘CL were studied in the There were 26 males and I:! females, and

patient age ranged between 11 and 74 years with a median of 47 years (Table I). The diagnosis of PTCL was based on histologic and immunohistologic evaluation of a lymph node biopsy (23 cases) and/or of other tissue samples: spleen (four cases), liver (eight cases), skin (six cases), peripheral nerve (one case), ileon (one case), Waldeyer ring (one case), and BM, which was the only material available tin. diagnosis in five cases (nos. 14, 32, 34. 3.5, and 37). The lymphomas were classified according to the International Working Formulation,” and the updated Kiel classification.” Cases of granulated T-cell lymphocytosis and lymphoblastic lymphoma were not included in this study. Lymphomas were considered to be of peripheral T-cell derivation when the tumor cells lacked the CDL cortical thymocyte antigen and expressed one or more T-cell markers (CD2, CD3, (:D!I, CD7, CD4, and CDS). Tumor cells were negative for immunoglobulin light chains and for the CD19 and CD22 pan-B antigens.

Peripheral T-cell lymphomas (P’KL) constitute a heterogeneous group of non-Hodgkin’s lymphomas’m’4 that are often disseminated at presentatioIlu-“,~l, I I. I :( a*ld seem to have a poor progno~is~S.i.!~,lO.IL’-1i These,lymphomas are characterized by a high incidence of extranodal localization.“-.‘,“-’ ‘.‘J and hone marrow (BM) appears to be involved in 1 1% ‘, to HO%,‘I’ of the patients. The pathology of BM in PTCL has been the sub-

Bone Marrow Biopsies

From the DC-partement de Pathologie Tissulaire et Cellulaire. the DCpal-temrnt d’Hkmatologie Clinique. and INSEKM Y-9 1, HApital Henri Mondor, Crkteil. France. Accepted for publication lune 12. 1090. Suppot-ted by (irant No. 1 IGYIRI from the IYniversiti Paris Val de Marne, (:t+teil. France. Kc) u~or~&: peripheral Trelt lymphoma. bone marrow. hisropatholbgy, trozen-sertiotl immunohistochemistry. Address correspondence and reprint requests to Philippe C;aulard, MD, DPpartement de Pathologie Tissulaire et Ckllulaire. Service d’ Anatomic et de Cytologic Pathologiques. Hi,pital Henri Mondor, !94 0 IO CrCteil. France. Copyright 0 1991 by W.B. Saunders Cornpan\ 0046-X 177&I 112204.0006$5.00/~

Unilateral bone marrow trephine biopsies were performed on the posterior superior iliac spine with a Jamshidi needle. Forty-three BM biopsies from the 38 patients were available. They were obtained at presentation (37 cases) and during the course of the disease, especially when a relapse occurred (six cases).

Tissue Specimen Preparation Fresh tissue samples of the 43 BM biopsies and of the initial diagnostic tissue specimen were divided into two portions. One portion was processed for rcjutine histologic

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HUMAN PATHOLOGY

TABLE 1. Case No. la lb 2 3 4 : 7a 7b 8 9 IO II 12 13a 13b I4 I5 16 17a 17b I8 19 20 21 22 23 24 25 26 27 28 29 30 31 32a 32b 33 34 35 36 37 38

Volume 22, No. 4 (April 1991)

Histologic, Immunohistochemical, and Genotypic Findings at Primary Site of Involvement by Peripheral T-cell Lymphoma

Age/Sex 51/M 47/M 40/M 23/M 63/M 28/M 26/M 27/F 23/M 27/M 52/F 57lM 36/M 39/F .56/F 70/M 32/M 49/F 38/M 65/M 11/M 58/M 52/M 66/F 69/F 54lM 30/M 44/M 68/F 71/M 65/M 29/M 65/M 32/F 24/F 64/M 74lF 35/F

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Llnclt Unclt Cnclt DM DM DM SL DM DLC DM DM DM DM DM DM Llnclt IBL DLC LCA DM DM DM DLC DLC DM DLC DLC DLC

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