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Role of Immunohistochemistry in Acute Leukemias with Myelonecrosis

  • Subramanian Kalaivani
  • Gurusamy Dharma Saranya
  • Rakhee Kar
  • Debdatta Basu
Short Communication

Abstract

Myelonecrosisis a rare antemortem finding most commonly seen in haematopoeitic neoplasms, especially in acute leukemia. When myelonecrosis occurs at the time of presentation, it imposes certain diagnostic issues in sub categorization of leukemias which is necessary for therapeutic as well as prognostic purposes. Flow cytometry, though is a powerful modality, has its own limitations especially when the cells are not fresh and viable; and when the specimen is not of adequate cellularity which is usual in cases of myelonecrosis. In such situations, immunocytochemistry (ICC) or immunohistochemistry (IHC) may play a major role in lineage specification in leukemias as the necrosed marrow with the ghost cells can still retain the antigenicity for certain immunomarkers. Four such interesting cases of common B acute lymphoblastic leukemia (ALL) where IHC was used for diagnosis were included. ICC and IHC done on the necrosed marrow contributed to the diagnosis of ALL in all the four cases and contributed to subsequent management. ICC and IHC if contributory can play a major role in identifying the primary cause of myelonecrosis as the ghost cells can retain the antigenicity despite being morphologically non-viable.

Keywords

Acute lymphoblastic leukemia Immunocytochemistry Immunohistochemistry Myelonecrosis Necrobiosis 

Notes

Compliance with Ethical Standards

Conflict of interest

None.

Research Involving Human Participants and/or Animals

Humans; Routine diagnostic material.

Ethical Approval

Study presented is as per ethical guidelines. It describes a series of four cases where all work up was part of routine diagnosis with de-identified patient details.

References

  1. 1.
    Habboush HW, Hann IM (1987) Bone marrow necrosis in acute lymphoblastic leukemia. Scot Med J 32:177–180CrossRefGoogle Scholar
  2. 2.
    Rekha JS, Kar R, Basu D (2014) Myelonecrosis: a clinicopathological study from a tertiary care center in south India over a twelve-year period. Bone Marrow Res.  https://doi.org/10.1155/2014/890510 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Paydas S, Ergin M, Baslamisli F, Yavuz S, Zorludemir S, Sahin B et al (2002) Bone marrow necrosis: clinicopathologic analysis of 20 cases and review of the literature. Am J Hematol 70(4):300–305CrossRefGoogle Scholar
  4. 4.
    Keren DF, McCoy JP, Carey JL (2001) Flow cytometry in clinical diagnosis, 3rd edn. American Society of Clinical Pathology Press, Chicago, p 739Google Scholar
  5. 5.
    Cassileth PA, Brooks JSJ (1987) The prognostic significance of myelonecrosis after induction therapy in acute leukemia. Cancer 60:2363–2365CrossRefGoogle Scholar
  6. 6.
    Jassens AM, Offner FC, Van Hove WZ (2000) Bone marrow necrosis. Cancer 88:1769–1780CrossRefGoogle Scholar
  7. 7.
    Granot H, Polliack A, Matzner Y (1980) Bone marrow necrosis as the only manifestation of disseminated carcinomatosis. Acta Haematol 64:232–235CrossRefGoogle Scholar
  8. 8.
    Itoh T, Orba Y, Takei H, Ishida Y, Saitoh M, Nakamura H et al (2002) Immunohistochemical detection of hepatocellular carcinoma in the setting of ongoing necrosis after radiofrequency ablation. Mod Pathol 15(2):110–115CrossRefGoogle Scholar
  9. 9.
    Ioachim HL, Medeiros LJ. Lymph node infarction. In: Ioachim's lymph node pathology, 4th edn. Lipincott Williams & Wilkins, pp 260–262Google Scholar
  10. 10.
    Mori E, Enomoto Y, Nakamine H, Kasai T, Takeda M, Takano M et al (2012) Lymph node infarction in classical Hodgkins lymphoma. J Clin Exp Hematopathol 52(1):35–39CrossRefGoogle Scholar
  11. 11.
    Strauchen JA, Miller LK (2003) Lymph-node infarction. An immunohistochemical study of 11 cases. Arch Pathol Lab Med 127:60–63PubMedGoogle Scholar
  12. 12.
    Kojima M, Nakamura S, Yamane Y, Murayama K, Shimizu K, Itoh H et al (2004) Antigen preservation in infarcted nodal B-cell lymphoma, with special reference to follicular center. Cell Mark 12(3):251–255Google Scholar

Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  • Subramanian Kalaivani
    • 1
  • Gurusamy Dharma Saranya
    • 1
  • Rakhee Kar
    • 1
  • Debdatta Basu
    • 1
  1. 1.Department of PathologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PuducherryIndia

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