MOLECULAR EVIDENCE OF BONE-MARROW INVOLVEMENT IN ADVANCED CASE OF T-GAMMA-DELTA LYMPHOMA WITH SECONDARY MYELOFIBROSIS

We describe the case of a middle-aged man with long indolent course of generalized T gamma delta lymphoma. The onset of secondary myelofibro sis made cytological monitoring of the bone marrow infiltrates impossi ble. As during progression of the disease splenectomy revealed typical histological features of a high-grade hepatosplenic T gamma delta lym phoma, the low-grade bone infiltrate was considered a secondary lympho ma. The use of the polymerase chain reaction helped to detect a consta nt and identical monoclonal rearrangement pattern of the T-cell recept or gamma-chain gene in both bone marrow and splenic T-cell infiltrates . The notion of a secondary spread of malignant T-cells to the bone ma rrow was thereby confirmed despite striking cytological differences be tween bone marrow and splenic infiltrates. This is the first report of a diagnostic DNA-based molecular approach using fixed decalcified bon e marrow. This method may provide a major tool when dealing with myelo fibrosis, which normally hampers sampling of cytological specimens. Co pyright (C) 1998 by W.B. Saunders Company.