• Fauzia Shafi Khan
  • Rabiya Fayyaz Hasan


Background: Hodgkin’s disease is a malignant process of lymphoreticular system that constitutes6% of childhood cancers Accurate staging of lymphoma is the basis for rational therapeutic planningand assessment of the presence or absence of marrow involvement is a basic part of the stagingevaluation. The objective of this study was to determine the incidence of marrow infiltration inpaediatric patients with Hodgkin’s disease and to ascertain its morphological spectrum in themarrow. Methods: The study included 85 paediatric patients with diagnosed Hodgkin’s disease seenat The Children’s Hospital/Institute of Child Health, Lahore, from January 2010 to December 2011,referred to haematology department for bone marrow biopsies. Results: Ages ranged between twoyears to fourteen years with an average age of seven years, the male female ratio being 13:1. Mixedcellularity was the commonest histological type present in 66 (78%) cases. The presenting featurecommon in all cases was superficial lymphadenopathy followed by hepatomegaly in 17 (20%) casesand splenomegaly in 16 (19%). All the marrow aspirates were negative for infiltration, Trephinebiopsies revealed marrow infiltration in 9 (10.5%). Five (56%) cases had bilateral while 4 (44%) hadunilateral involvement. Pattern of infiltration was diffuse in 8 (89%) and focal in one (11%)trephines. Increased marrow fibrosis was present in eight (89%) cases. Diagnostic Reed Sternbergcells were identified in only one case and the mononuclear variants were present in six cases andatypical cells were present in two cases in these immunohistochemistry for CD15 and CD30 wasperformed which was positive. Granulomas in one and lymphoid aggregates were present in twotrephine biopsies otherwise negative for Hodgkin’s infiltration. Conclusion: Bone marrowinfiltration was present in 10.5% cases, immunohistochemistry was used to confirm infiltration intwo cases, the pattern of infiltration being diffuse in majority (89%).Keywords: Hodgkin’s Disease, Bone marrow biopsy


Cairo MS, Bradley MB. Hodgkin’s lymphoma. In: Nelson’s

Textbook of Pediatrics. Philadelphia: WB Saunders Company;


Gutensosohn N, Cole P. Childhood social environment and

Hodgkin’s Disease. N Engl J Med 1981;304:135–40.

Firki F, Chesterman C, Penington D, Rush (Eds). de Gruchy’s

Clinical Haematology. In: Medical Practice Delhi: Blackwell

Scientific Publications; 1990.286.

MacMohan B. Epidimiologic considerations in staging of

Hodgkin’s disease. Cancer Res 1971;31:1854–7.

Sheehan T, Parker AC. Hodgkin’s disease. In: Ludlam CA (Ed).

Clinical Haematology. 1st ed. Edinburgh: Churchill Livingstone;


Sive J, Linch D. Hodgkin’s lymphoma. In: Hofbrand AV,

Catovsky D, Tuddenham EG, Green AR (Eds). Postgraduate

Haematology. 6rd ed. Oxford: Blackwell Publishing Ltd.; 2011.

J Ayub Med Coll Abbottabad 2012;24(2) 57


Rosenberg SA. Hodgkin’ Disease of the bone marrow. Cancer

Res 1971;31:1733–6.

Han T, Stutzman L, Roque AL. Bone marrow biopsy in

Hodgkin’s disease and other neoplastic diseases. JAMA


Bain BJ, Clark DM, Lampert IA (Eds). Bone Marrow Pathology.

nd ed. London: Blackwell Scientific Publications; 1996.p.212.

Brunning RD, Bloomfield CD, McKenna RW, Peterson L.

Bilateral trephine bone marrow biopsies in lymphoma and other

neoplastic disorders. Ann Intern Med 1975;82:365–6.

Juneja SK, Wolf MM, Cooper IA. Value of bilateral bone

marrow biopsy specimens in non Hodgkin’s lymphoma. J Clin

Pathol 1990;43:630–2.

Brunning RD. Bone marrow, In: Rosai J (Eds) Ackerman’s

Surgical Pathology. 7th ed. Washington: CV Mosby Company;


O Carroll DI, McKenna RW, Brunning RD. Bone Marrow

Manifestations Of Hodgkin’s Disease. Cancer 1976;38:1717–28.

McKenna RW, Hernandez JA. Bone marrow in malignant

lymphoma. In: Hyun BH (Ed). Hematology/Oncology Clinics of

North America. Philadelphia: WB Saunders Company;


Firsch B, Lewis SM, Burkhart R. Biopsy Pathology of bone and

bone marrow. London: Chapman and Hall; 1985.p.304.

Rappaport H, Berard CW, Butler JJ, Dorfman RF, Lukes RJ,

Thomas LB. Report of the committee on histopathological

criteria contributing to staging of Hodgkin’s disease. Cancer Res


Sive J, Linch D. Hodgkin’s lymphoma. In: Hofbrand AV,

Catovsky D, Tuddenham EG, Green AR (Eds). Postgraduate

Haematology. 6th ed. Oxford: Blackwell Publishing Ltd.;


Simpson CD, Gao J, Fernandez CV, Yhap M, Price VE, Berman

JN. Routine bone marrow examination in initial evaluation of

paediatric Hodgkin’s lymphoma: the Canadian perspective. Br J

Haematol 2008;141(6):820–6.

Mahoney DH, Schreuders LC, Gresik MV, McClain KL. Role of

staging bone marrow examination in children with Hodgkin’s

disease. Med Pediatr Oncol 1998;30(3):175–7.

Barros MH, Zalcberg IR, Hassan R. Clinical and laboratorial

prediction of bone marrow involvement in children and

adolescents with Hodgkin’s lymphoma. Pediatr Blood Cancer


Hines-Thomas MR, Howard SC, Hudson MM, Krasin MJ, Kaste

SC, Shulkin BL, Metager ML. Utility of bone marrow biopsy at

diagnosis in pediatric Hodgkin’s lymphoma. Haematologica


Marcus RH, WeinertL, Neumsnn A, Borow KM, Lang RM.

Venous air embolism. Diagnosis by spontaneous right sided

contrast echocardiography. Chest 1991;99(3):784–5.

Spector N, Nucci M, Oliveria De Morais A, Portugal RS, Costa

MA, et al. Clinical factors predictive of bone marrow

involvement in Hodgkin’s disease. Leuk Lymphoma


Dee JW, Valdivieso M, Drewinko B. Comparison of the

efficacies of closed trephine needle biopsy, aspirated paraffin

embedded clot section and smear preparation in the diagnosis of

bone marrow involvement by lymphoma. Am J Clin Pathol


Brunning RD, McKenna RW. Bone marrow lymphomas. In:

Brunning RD, McKenn RW, (Eds). Tumors of the Bone Marrow.

Atlas of Tumor Pathology. Third series, fascicle 9. Washington

DC: Armed Forces Institute of Pathology;1994:369–408.

Pillai G, Pezella F, Gatter K. Follicular pattern of bone marrow

involvement in lymphocyte predominant Hodgkin’s disease.

Histopathology 2003;43:203–5.

Lee R, Ellis LD. Histopathology aspects of marrow involved

with Hodgkin’s disease. Program of 17th Annual Meeting of the

American Society of Hematology, Atlanta. Georgia 1974;p.162.

Myers CE, Chabner BA, De Vita VT, Gralnick HR. Bone

Marrow Involvement in Hodgkin’s Disease: Pathology and

Response to MOPP Chemotherapy. Blood 1974;44;2(A4).

Kadin ME, Donaldson SS, Dorfman RF: Isolated granulomas in

Hodgkin’s disease. N Engl J Med 1970;283:859–61.

Jackson J Jr, Parker F Jr. Hodgkin’s Disease and Allied

Disorders. New York: Oxford University Press; 1947.pp.17–34.

Franco V, Tripodo C, Rizzo A, Stella M, Florena AM. Bone

marrow biopsy in Hodgkin’s lymphoma. Eur J Haematol


Watanbe K, Yamashita Y, Nakayama A, HasegawaY, Kojima H,

Nagasawa T, et al. Varied B cell immunophenotypes of

Hodgkin/Reed-Sternberg cell in classic Hodgkin’s disease.

Histopathology 2000;36:353–61.