Waldenström's macroglobulinemia bone marrow aspiration and biopsy

Waldenström's macroglobulinemia Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Roukoz A. Karam, M.D.[3]; Grammar Reviewer: Natalie Harpenau, B.S.[4]

Overview

A bone marrow aspiration and biopsy is essential in the diagnosis of Waldenström macroglobulinemia and shows hypercellular bone marrow, Dutcher bodies, and three patterns of bone marrow infiltration including lymphoplasmacytoid cells, lymphoplasmacytic cells in an interstitial/nodular pattern, and a polymorphous infiltrate.

Bone Marrow Aspirate

A bone marrow aspirate is essential in the diagnosis of Waldenström macroglobulinemia.

Findings suggestive of Waldenström macroglobulinemia include:

• A hypercellular bone marrow aspirate
• Lymphoplasmacytic infiltrate with characteristic immunophenotype

Bone marrow aspirate. Lymphocytes with lymphoplasmacytoid appearance (arrows).Source: D'Angelo G. et al, Laboratorio di Chimica-Clinica, Ematologia e Microbiologia (Ematologia/Coagulazione), Azienda Ospedaliera "S. Antonio Abate" di Gallarate, Varese, Italy.

Bone Marrow Biopsy

• A bone marrow biopsy may be helpful in the diagnosis of Waldenström macroglobulinemia.

• Findings on the biopsy suggestive of Waldenström macroglobulinemia include:
  • Hypercellular and infiltrated with lymphoid and plasmacytoid cells

• • Dutcher bodies (PAS positive intra-nuclear vacuoles containing IgM monoclonal protein)
    • Characteristic feature of Waldenström macroglobulinemia

• Three patterns of marrow involvement are described, as follows:

• • Lymphoplasmacytoid cells (lymphoplasmacytic and small lymphocytes) in a nodular pattern
  • Lymphoplasmacytic cells (small lymphocytes, mature plasma cells, mast cells) in an interstitial/nodular pattern
  • A polymorphous infiltrate (small lymphocytes, plasma cells, plasmacytoid cells, immunoblasts with mitotic figures)