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Lymph Nodes, Spleen, and Bone Marrow
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These organs are affected by a wide variety of neoplastic, infectious, and systemic diseases. These diseases can also arise in extranodal sites.
RELEVANT CLINICAL HISTORY
In addition to age and gender, clinical history is often necessary or helpful for the interpretation of specimens of lymph nodes, spleen, or bone marrow ( Table 23.1 ).
Table 23.1
RELEVANT CLINICAL HISTORY FOR SPECIMEN FROM LYMPH NODES, SPLEEN, BONE MARROW, AND OTHER EXTRANODAL SPECIMENS
| HISTORY RELEVANT TO ALL SPECIMENS | HISTORY RELEVANT FOR LYMPH NODE, SPLEEN, BONE MARROW, AND OTHER EXTRANODAL SPECIMENS |
| Organ/tissue resected or biopsied | Lymphadenopathy |
| Purpose of the procedure | Organomegaly (liver or spleen) |
| Gross appearance of the organ/tissue/lesion sampled | Hematologic findings (e.g., pancytopenia or lymphocytosis) |
| Any unusual features of the clinical presentation | Helicobacter pylori infection |
| Any unusual features of the gross appearance | LDH level (a poor prognostic factor that correlates with tumor burden) |
| Prior surgery/biopsies - results | Constitutional symptoms (e.g., night sweats, fever) |
| Prior malignancy | |
| Prior treatment (radiation therapy, chemotherapy, drug use that can change the histologic appearance of tissues) | Congenital immune disorders |
| Organ transplantation (solid organ or bone marrow) | |
| Positive serology (e.g., HTLV-1, Epstein-Barr virus) | |
| Compromised immune system | Autoimmune disease |
Bone Marrow
Bone marrow biopsies are performed to evaluate suspected hematologic disorders or for the staging of carcinomas and lymphomas.
In general, decalcification using strong acids (e.g., hydrochloric acid) decreases antigenicity of some epitopes (predominantly nuclear) but may not alter others (predominantly cytoplasmic). Weaker acids including EDTA and formic acid (if used for a brief time) have fewer effects on antigenicity. If the biopsy was performed to evaluate for metastatic carcinoma, any soft tissue should be processed without decalcification or, if necessary, the time should be minimized.
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PROCESSING THE SPECIMEN
- 1.
Describe the number of fragments, shape (tubular, irregular), and dimensions (length and diameter).
- 2.
Biopsies are optimally fixed in Bouin’s solution overnight. Longer fixation over a weekend for 1 to 2 days is acceptable. Some pathology departments use Zenker’s fixative.
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After adequate fixation, the specimen is briefly decalcified. If the specimen is easily bent, decalcification is adequate. The time for decalcification should be minimized, as this treatment can alter histologic detail and diminish immunoreactivity.
- 4.
The specimen is placed into formalin after decalcification. If more than one core is present, tissue can also be fixed in B-Plus.™
- 5.
Wrap the cores in lens paper and submit the entire specimen using separate cassettes for each type of fixative (e.g., formalin and B-Plus™).
- 6.
Describe any blood or aspirate smears received with the biopsy. Unstained smears are stained with Wright Giemsa.
- 7.
Order two H&E stains and one Giemsa stain for routine cases.
SPECIAL STUDIES ON BONE MARROW BIOPSIES
Suspected metastatic disease: Breast carcinoma often metastasizes to bones, and biopsies are frequently performed for diagnosis. Bouin’s fixation as well as decalcification can diminish immunoreactivity for hormone receptors. To avoid false-negative results, specimens should be processed in formalin and without decalcification, if possible. If the immunohistochemical studies for hormone receptors are negative, the possibility of a false-negative result should be considered.
Suspected infectious disease (e.g., in immunocompromised patients): Special stains for organisms can be ordered on formalin-fixed sections (e.g., AFB and silver stains).
Myelodysplastic syndromes or myeloproliferative neoplasms: Reticulin and trichrome stains may be ordered to evaluate marrow fibrosis. Iron stains may performed to evaluate the presence of ring sideroblasts but are more sensitive if performed on bone marrow aspirates.
SAMPLE DICTATION
Received in saline labeled with the patient’s name and unit number and “right iliac” is a 1.5 cm in length by 0.4 cm in diameter bone marrow biopsy. Accompanying the specimen are two unstained coverslips that are submitted for Wright Giemsa staining. The specimen is fixed in Bouin’s solution overnight and then briefly decalcified and transferred to formalin. The specimen is entirely submitted for microscopic evaluation.
Micro A1: 1 frag.
Lymph Nodes
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