Phagocytized neutrophil fragments in the bone marrow: a phenomenon most commonly associated with hodgkin lymphoma

Abstract

Bone marrow macrophages containing other cells, or large pieces of other cells, represent a distinctive feature of diseases such as Hemophagocytic Lymphohistiocytosis (HLH) and Rosai-Dorfman disease. We describe a distinct variation of phagocytic histiocyte morphology, featuring histiocytes containing predominantly fragments of neutrophil nuclei. We retrospectively reviewed initial bone marrow samples for Hodgkin lymphoma, Burkitt lymphoma, Ewing sarcoma, or evaluation for nonneoplastic conditions, scoring the presence or absence of the above-described histiocytes. We find that these histiocytes, which we term "fragmentophages," are associated with staging marrow sampling for malignancy, especially Hodgkin lymphoma (Hodgkin lymphoma: 28/34 or 82.4%, Ewing sarcoma: 11/26 or 42.3%, Burkitt lymphoma: 4/13 or 30.8%). These cells are significantly less common in marrow samples for nonneoplastic conditions (4/21 or 19.0%). Fragmentophages are significantly associated with malignancy, especially Hodgkin lymphoma, and their recognition has the potential to provide a clue to an underlying malignancy.

Figure 1

Macrophages containing granulocyte nuclear debris. Macrophages containing granulocyte nuclear debris can be seen dispersed throughout marrow biopsies in H&E stained sections ((a) H&E 40x objective magnification, (b) H&E 100x oil objective magnification) and aspirate marrow smears ((c) Wright-Giemsa 100x oil). Immunohistochemical staining for myeloperoxidase highlights the phagocytosed cells ((d) 100x oil). H&E: Hematoxylin and Eosin.

Figure 2

Distinct histologic features of macrophages containing other cell types. Macrophages containing neutrophils, or “fragmentophages,” show cytoplasmic inclusion of cells with lobulated nuclei ((a) H&E 100x oil). In contrast, HLH features macrophages containing red blood cells ((b) Wright-Giemsa 100x oil) and Rosai-Dorfman with macrophages containing intact lymphocytes ((c) Wright-Giemsa 100x oil). Tingible body macrophages are distinguished by cytoplasm which contains a range of fragments, from whole lymphocytes to small debris ((d) Wright-Giemsa 100x oil).

Figure 3

Distribution of bone marrow macrophages containing neutrophils by underlying diagnosis.