Significance of Bone Marrow Histology in the Diagnosis of Acute Myeloid Leukemia

Abstract

Background:  Acute Myeloid Leukemia (AML) is a heterogeneous disease. The precise diagnosis requires a careful morphological examination of a well pre-pared bone marrow aspirate along with flow cytometry and genetic analysis wherever required. Traditionally, bone marrow biopsy has not been considered an essen-tial diagnostic modality for AML. The aim of this stu-dy was to assess the diagnostic as well as prognostic significance of bone marrow histology in patient with acute myeloid leukemia.
Materials and Methods:  Forty (40) patients of AML underwent a bone marrow examination including an aspirate and a trephine biopsy. Air dried films of peri-pheral blood and aspirates were fixed in methanol and stained with Giemsa. The following cytochemical stai-ns were also applied: PAS, Myeloperoxidase, Non specific esterase, Chloracetate Esterase and Acid Phos-phatase, and SBB. Bone marrow biopsy specimens were obtained from post superior iliac crest with a manual trephine and were processed in plastic after decalcification.

Results:  In all the cases there were better diagnostic clues through histological examination of bone mar-row particularly in assessing the cellularity, degree of fibrosis, extent of blast infiltration, percentage of infla-mmatory cells, dysplastic changes and residual haema-topoiesis. All these features were better noted in histo-logical examination of core biopsy.

Conclusion:  The histological examination provided information additional to that provided by aspirate smears about the bone marrow changes in AML and suggested that some of the features may also have pro-gnostic significance in addition to diagnostic impor-tance.

Key Words:  Acute myeloid leukemia, Bone marrow biopsy, bone marrow histology.