Bone marrow aspiration

The patient, a 22-year-old female, was diagnosed with diffuse large B-cell lymphoma (an aggressive non-Hodgkin’s lymphoma). The patient had completed 6 cycles of R-CHOP (from March 2018 to July 2018). After that, the patient was re-examined regularly monthly (manifested with moderate and hypochromic anemia, bone marrow aspiration was negative for malignancy).

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Pathophysiology Bone marrow failure results from severe damage to the hematopoietic cell compartment. In aplastic anemia, replacement of the bone marrow by fat is apparent in the morphology of the biopsy specimen (Fig. 102-1) and MRI of the spine. Cells bearing the CD34 antigen, a marker of early hematopoietic cells, are greatly diminished, and in functional studies, committed and primitive progenitor cells are virtually absent; in vitro assays have suggested that the stem cell pool is reduced to ≤1% of normal in severe disease at the time of presentation. Figure 102-1 A.

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Bone Marrow The bone marrow is usually readily aspirated but dilute on smear, and the fatty biopsy specimen may be grossly pale on withdrawal; a "dry tap" instead suggests fibrosis or myelophthisis.

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Lymphomas Lymphoma in the small bowel may be primary or secondary. A diagnosis of a primary intestinal lymphoma requires histologic confirmation in a clinical setting in which palpable adenopathy and hepatosplenomegaly are absent and no evidence of lymphoma is seen on chest radiograph, CT scan, or peripheral blood smear or on bone marrow aspiration and biopsy. Symptoms referable to the small bowel are present, usually accompanied by an anatomically discernible lesion.

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Staging of Small Cell Lung Cancer Pretreatment staging for patients with SCLC includes the initial general lung cancer evaluation with chest and abdominal CT scans (because of the high frequency of hepatic and adrenal involvement) as well as fiberoptic bronchoscopy with washings and biopsies to determine the tumor extent before therapy; brain CT scan (10% of patients have metastases); and radionuclide scans (bone) if symptoms or other findings suggest disease involvement in these areas.

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Bone Marrow Examination A bone marrow aspirate and smear or a needle biopsy may be useful in the evaluation of some patients with anemia. In patients with hypoproliferative anemia and normal iron status, a bone marrow is indicated. Marrow examination can diagnose primary marrow disorders such as myelofibrosis, a red cell maturation defect, or an infiltrative disease (Figs. 58-14, 58-15, and 58-16). The increase or decrease of one cell lineage (myeloid vs.

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