Granulomas in bone marrow--a study of fourteen cases.

Granulomas in bone marrow are an infrequent finding and several diseases are associated with granuloma formation. Clinicopathological details of fourteen cases showing granulomas in bone marrow were studied. Fever was the commonest clinical presentation and anaemia was seen in all cases. Only one case showed epithelioid cells in the bone marrow aspirate smear while trephine biopsy was diagnostic in all cases. Granulomas were seen mainly in the paratrabecular space. Acid fast bacilli were demonstrated in five biopsies and serological test for Human Immunodeficiency virus was positive in five cases. Tuberculosis was more common in the present study as compared to others, probably due to the endemicity of tuberculosis in this region. Bone marrow biopsy is useful in the investigation of pyrexia of unknown origin as it leads to an aetiological diagnosis in most cases.

Bone marrow cryptococcosis: a case report.

A 35-year-old male presented with fever and bilateral cervical and axillary lymphadenopathy. Peripheral blood film examination revealed thrombocytopaenia. Bone marrow aspiration and trephine biopsy, done for evaluation of thrombocytopaenia and pyrexia showed presence of ill-defined granulomas along with cryptococcal yeast forms. Fine needle aspiration of lymph nodes, cerebrospinal fluid and sputum analyses also showed cryptococci. ELISA for Human Immunodeficiency Virus (HIV) antigen was positive. Granulomas, when found in bone marrow aspiration smears and trephine biopsy, are a valuable histological clue to an opportunistic infection. Disseminated fungal infection such as cryptococcosis should raise the possibility of immunosuppression, especially Acquired Immunodeficiency Syndrome. Bone marrow examination is a useful method of diagnosing opportunistic fungal and mycobacterial infections in patients with fever, anaemia or thrombocytopaenia and underlying HIV infection.

Fibroblastic Reticulum Cell Tumor of Spleen: A Case Report.

Fibroblastic reticulum cells (FBRCs) belong to a major subtype of stromal support cells in the lymphoid system and rarely give rise to tumors. We report a case of fibroblastic reticulum cell tumor arising in the spleen. The tumor was clinically and radiologically mistaken for a metastatic deposit in the spleen. Microscopically the tumor was composed of spindle cells arranged in fascicles and storiform pattern. The cells had oval to elongated vesicular nuclei and pale eosinophilic cytoplasm with indistinct cell borders. There were admixed inflammatory cells, including large numbers of plasma cells. The tumor cells were positive for smooth muscle actin, desmin, AE1/AE3, and MNF116. They were negative for S100, CD1a, CD21, CD23, CD34, CD31, and CD35 among other markers. The morphological features and immunoprofile of this rare tumor in comparison to the few cases reported in the literature are discussed along with the positive reaction with cytokeratins and their relationship to the smaller subset of FBRCs, the cytokeratin-positive interstitial reticulum cells in the spleen.