Bone Marrow Granulomas: A Retrospective Study of 47 Cases (A Single Centre Experience)
American Journal of Internal Medicine
Volume 2, Issue 5, September 2014, Pages: 90-94
Received: Sep. 11, 2014;
Accepted: Sep. 29, 2014;
Published: Oct. 20, 2014
Views 3169 Downloads 196
Sampath Kumar-Kandala Jeevan, Departments of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India
Roshni Paul-Tara, Departments of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India
Shantiveer Uppin, Departments of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India
Megha Uppin, Departments of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, India
Background: Granulomas in bone marrow are an infrequent finding; however several diseases may be associated with granuloma formation and an etiologic diagnosis is essential. Bone marrow examination plays an important role in the diagnosis of various disorders associated with bone marrow granulomas and is useful in the investigation of pyrexia of unknown origin (PUO) as it leads to an etiological diagnosis in many of the cases. Aim: This study was undertaken to ascertain the frequency and etiological background of bone marrow granulomas. Material and methods: In the present study, forty seven cases with bone marrow granulomas were included. Clinical details, peripheral blood and marrow morphological findings were analyzed. Results: Pyrexia of unknown origin was the commonest presentation and anemia was noted in all cases. Twenty five cases had associated clinical conditions, including 7 with past history of tuberculosis and 8 with retroviral disease. Of the 47 cases, 7 showed granulomas in bone marrow aspiration, while bone marrow biopsy was diagnostic in all cases. Caseous necrosis was seen in 11(23.4%) cases. Acid fast bacilli were demonstrated in one bone marrow aspirate. Culture studies grew Brucella organisms in one case. Tuberculosis was the commonest in the present study as compared to other studies probably due to the endemicity of tuberculosis in this region. Conclusion: If the granuloma is associated with caseous necrosis and Langhan giant cells and correlated with clinical features, a possibility of the tuberculous etiology may be suggested to allow empirical treatment to be initiated before microbiological confirmation.
Sampath Kumar-Kandala Jeevan,
Bone Marrow Granulomas: A Retrospective Study of 47 Cases (A Single Centre Experience), American Journal of Internal Medicine.
Vol. 2, No. 5,
2014, pp. 90-94.
Toi PC, Varghese RG, Rai R. Comparative evaluation of simultaneous bone marrow aspiration and bone marrow biopsy: an institutional experience. Indian J. Hematol. Blood Transfus. Off. J. Indian Soc. Hematol. Blood Transfus. 2010 Jun;26(2):41–4.
Laing RBS. Fever and Pyrexia of Unknown Origin. Medicine 2001; 29:24-6.
Vilalta-Castel E, Valdés-Sanchez MD, Guerra-Vales JM, Teno-Esteban C, Garzón A, López JI, et al. Significance of granulomas in bone marrow: a study of 40 cases. Eur. J. Haematol. 1988 Jul;41(1):12–6.
Bodem CR, Hamory BH, Taylor HM, Kleopfer L. Granulomatous bone marrow disease. A review of the literature and clinicopathologic analysis of 58 cases. Medicine (Baltimore). 1983 Nov;62(6):372–83.
Bhargava V, Farhi DC. Bone marrow granulomas: clinicopathologic findings in 72 cases and review of the literature. Hematol. Pathol. 1988;2(1):43–50.
Vijnovich Barón IA, Barazzutti L, Tartas N, Korin J, Sánchez Avalos JC. [Bone marrow granulomas]. Sangre (Barc.). 1994 Feb;39(1):35–8.
PEASE GL. Granulomatous lesions in bone marrow. Blood. 1956 Aug;11(8):720–34.
Basu D, Saravana R, Purushotham B, Ghotekar LH. Granulomas in bone marrow--a study of fourteen cases. Indian J. Pathol. Microbiol. 2005 Jan;48(1):13–6.
Nichols L, Florentine B, Lewis W, Sattler F, Rarick MU, Brynes RK. Bone marrow examination for the diagnosis of mycobacterial and fungal infections in the acquired immunodeficiency syndrome. Arch. Pathol. Lab. Med. 1991 Nov;115(11):1125–32.
Gupta R, Setia N, Arora P, Singh S, Singh T. Hematological profile in pyrexia of unknown origin: role of bone marrow trephine biopsy vis-à-vis aspiration. Hematol. Amst. Neth. 2008 Oct;13(5):307–12.
Chandra S, Chandra H. Comparison of bone marrow aspirate cytology, touch imprint cytology and trephine biopsy for bone marrow evaluation. Hematol. Reports. 2011 Oct 19;3(3):e22.
Nakajima M, Niki Y, Manabe T, Matsushima T. [Detection of lesions in bone marrow for the diagnosis of miliary tuberculosis: reliability of bone marrow aspiration and biopsy in view of distribution pattern of lesions in autopsy cases]. Kansenshōgaku Zasshi J. Jpn. Assoc. Infect. Dis. 1996 Sep;70(9):963–9.
Eid A, Carion W, Nystrom JS. Differential diagnoses of bone marrow granuloma. West. J. Med. 1996 Jun;164(6):510–5.
Paradela A, Rivas C, Fernández-Guerrero M, Román A. [Histopathology of bone marrow biopsy in patients with human immunodeficiency virus infection]. Rev. Clínica Española. 1996 Jan;196(1):9–15.
Richman DD, Fischl MA, Grieco MH, Gottlieb MS, Volberding PA, Laskin OL, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N. Engl. J. Med. 1987 Jul 23;317(4):192–7.
Greiner J, Schmitt M, Li L, Giannopoulos K, Bosch K, Schmitt A, et al. Expression of tumor-associated antigens in acute myeloid leukemia: Implications for specific immunotherapeutic approaches. Blood. 2006 Dec 15;108(13):4109–17.
Kishore J, Kumar R, Choudhry VP, Bhargava M. Circulating immune complexes in leukaemias and lymphomas. Indian J. Pediatr. 1992 Apr;59(2):225–31.
Sacks EL, Donaldson SS, Gordon J, Dorfman RF. Epithelioid granulomas associated with Hodgkin’s disease: clinical correlations in 55 previously untreated patients. Cancer. 1978 Feb;41(2):562–7.
Abrams J, Pearl P, Moody M, Schimpff SC. Epithelioid granulomas revisited: long-term follow-up in Hodgkin’s disease. Am. J. Clin. Oncol. 1988 Aug;11(4):456–60.
Lui SL, Tang S, Li FK, Choy BY, Chan TM, Lo WK, et al. Tuberculous infection in southern Chinese renal transplant recipients. Clin. Transplant. 2004 Dec;18(6):666–71.
Wang B, Lü Y, Yú L, Liu C, Wu Z, Pan C. Diagnosis and treatment for tuberculosis infection in liver transplant recipients: case reports. Transplant. Proc. 2007 Dec;39(10):3509–11.
Higgins RM, Cahn AP, Porter D, Richardson AJ, Mitchell RG, Hopkin JM, et al. Mycobacterial infections after renal transplantation. Q. J. Med. 1991 Feb;78(286):145–53.
Queipo JA, Broseta E, Santos M, Sánchez-Plumed J, Budía A, Jiménez-Cruz F. Mycobacterial infection in a series of 1261 renal transplant recipients. Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis. 2003 Jun;9(6):518–25.
Prasoon D. Acid-fast bacilli in fine needle aspiration smears from tuberculous lymph nodes. Where to look for them. Acta Cytol. 2000 Jun;44(3):297–300.
Jha A, Sarda R, Gupta A, Talwar OP. Bone marrow culture vs. blood culture in FUO. Jnma J. Nepal Med. Assoc. 2009 Jun;48(174):135–8.
Wain J, Pham VB, Ha V, Nguyen NM, To SD, Walsh AL, et al. Quantitation of bacteria in bone marrow from patients with typhoid fever: relationship between counts and clinical features. J. Clin. Microbiol. 2001 Apr;39(4):1571–6.