—  SHORT COURSE  —

THE VALUE OF IMMUNOHISTOCHEMISTRY
IN THE ASSESSMENT OF BONE MARROW DISORDERS

Attilio Orazi, M.D., FRCPath. and Dennis P. O'Malley, M.D.




METASTATIC MALIGNANCY FROM UNKNOWN PRIMARY SOURCE

In most series, a primary site of origin for the metastatic malignancy is identified in only 15% of the cases prior to death. Whether a primary site is identified or not, survival usually is short with a median of 6 months. There is considerable variation in the incidence of bone marrow metastasis for various types of malignancies. Some of the most common neoplasms also have the highest incidence of marrow involvement. These include carcinomas of the breast (up to 20%), prostate (13-20%), lung (SCC, 3-15%; adenocarcinoma, 5 to 10%) and gastrointestinal tract (4%; mostly stomach and colon) in adults; and neuroblastomas (50-60%) in children. The variability in the reported incidence for these tumors may reflect differences in patient selection as well as in techniques used to identify metastatic involvement in the bone marrow. In our experience with neuroblastoma, a combined approach in which aspirate smears, touch preparations, bone marrow particle sections, and bilateral bone marrow biopsy are simultaneously obtained seems capable of providing the highest tumor yield.

Metastatic involvement of the bone marrow may be focal or diffuse. In osteolytic tumors the bone trabeculae show erosion and osteopenia. In the less common osteoblastic lesions (usually prostate and breast adenocarcinoma), irregular thickening of the bone trabeculae is usually observed. Selected antibodies which we find useful for the characterization of metastatic tumors in bone marrow are listed in.

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