Bone marrow histology in cold agglutinin disease (CAD)-associated lymphoproliferative disorder

Bone marrow histology reveals a lymphoproliferative disorder in a large proportion of individuals with primary cold agglutinin disease (CAD). Refer to UpToDate for clinical evaluation and management of CAD.

Panels A and B - H&E staining of bone marrow biopsy showing nodular lymphoid aggregates. Magnification 40X in A and 100X in B.
Panels C and D - Higher magnification shows small lymphoid cells with rounded nuclei lacking prominent nucleoli. Magnification 400X in E (H&E staining) and 600X in F (Giemsa staining).
Panel E - Immunoperoxidase staining for CD20 indicates that the nodular infiltrates consist of B cells.
Panel F - Mast cells are not usually present surrounding the infiltrates.
Panel G - Immunoperoxidase staining for CD138 demonstrates scarce plasma cells.
Panel H - Immunoperoxidase staining for IgM reveals abundant membrane IgM in the lymphoid cells express and cytoplasmic IgM in the plasma cells.

CAD: cold agglutinin disease; LPD: lymphoproliferative disease; BM: bone marrow; H&E: hematoxylin and eosin; IgM: immunoglobulin M.

Reproduced with permission from: Randen U, Troen G, Tierens A, et al. Primary cold agglutinin-associated lymphoproliferative disease: a B-cell lymphoma of the bone marrow distinct from lymphoplasmacytic lymphoma. Haematologica 2014; 99:497. Copyright © 2014 Ferrata Storti Foundation. All rights reserved.

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Bone marrow histology in cold agglutinin disease (CAD)-associated lymphoproliferative disorder