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R Bartl

Publications and source records attributed to R Bartl.

At least 91 records · Page 5Linked to original sources
PubMed1984

Lymphoproliferative disorders in the bone marrow: histologic criteria for classification and staging.

Malignant lymphoproliferative disorders (LPD) were investigated in bone marrow biopsies of 1565 untreated patients. Marrow involvement was found in 90 per cent of multiple myeloma (MM), 70 per cent of non-Hodgkin lymphomas (NHL) and 10 per cent of Hodgkin disease (HD). In MM and NHL there were five major entities according to the predominant proliferative cell type: 1. plasmacytic, 2. lymphocytic, 3. hairy cell, 4. immunocytic and 5. centrocytic. On the basis of bone marrow histology they were classified into 3 distinct sub-types each of which had an independent prognostic significance. The mode of spread of all the LPD fell into one of six architectural patterns which together with the tumour cell burden (the quantity of infiltration in the biopsy) also had a significant predictive value. Consequently, bone marrow biopsy is a valuable diagnostic tool for histologic classification and clinical staging of any patient with LPD.

Biopsy↗
PubMed1983

Bone marrow histology in hairy cell leukemia. Identification of subtypes and their prognostic significance.

Bone marrow biopsy specimens taken on initial investigation of 134 patients with hairy cell leukemia (HCL) were processed into plastic, and sections cut at 3 microns were used for histologic and histomorphometric evaluation. Twenty-four clinical, 10 histologic, and four histomorphometric variables were tested for their prognostic significance. Bone marrow involvement was found in all cases, and on the basis of their morphology, the hairy cells were divided into three types: ovoid (47%), convoluted (37%), and indented (16%); this classification proved to be highly significant in the test statistics, with median survivals for the three groups of 56, 12, and 5 months, respectively. The characteristic nuclear features of the three types also were identified in smears of peripheral blood, in sections of spleen, and by electron microscopy. In addition, significant differences were found when the patients were grouped according to the tumor cell mass (volume %) in the biopsy sections, with median survivals of 55, 21, and 8 months noted for less than 20 vol%, 20-50 vol%, and greater than 50 vol%, respectively. Other factors with prognostic relevance were cytoplasmic inclusion bodies in the hairy cells (HC) and a number of clinical variables, including initial values of Hb and ESR, and platelets and monocytes in the peripheral blood. These results confirm that the bone marrow always is involved in HCL and its histology is diagnostic; that HCL may be classified according to the predominant neoplastic cell type; and that the patients may be staged on the basis of the tumor cell burden in the bone marrow biopsy.

Adult↗
PubMed1983

Bone marrow histology in Waldenström's macroglobulinaemia. Clinical relevance of subtype recognition.

Bone marrow biopsies of 137 patients with Waldenström's macroglobulinaemia (WM), 26 with non-secretory immunocytoma and 32 with benign monoclonal gammopathy were processed for histologic evaluation. Bone marrow involvement was found in 110 (80%) initially, and in 24 (18%) in sequential biopsies. 3 types were distinguished: lymphoplasmacytoid (47%), lymphoplasmacytic (42%) and polymorphous (11%) with median survivals of 74, 25 and 12 months, respectively. When grouped according to the tumour cell mass in the biopsies, the median survivals were 55, 21 and 8 months for less than 20 vol%, 20-50 vol% and greater than 50 vol% respectively; in each subtype, the tumour cell mass correlated with the disease progression. 6 clinical variables were also found prognostically significant. These results demonstrate that (i) 98% of patients with WM have bone marrow involvement; (ii) the lymph node sub-classification is applicable to the bone marrow and has both clinical and prognostic significance; (iii) patients may be staged according to the tumour cell burden in the bone marrow biopsy.

Adult↗
PubMed1982

Ph1 -positive CML associated with megakaryocytic hyperplasia and thrombocythemia and an abnormality of chromosome no. 3.

A patient with Philadelphia (Ph1) chromosome positive chronic myelocytic leukemia is described, who had in blast crisis in addition an abnormality of chromosome No. 3; ins(3; 3)(q26; q21q26). This abnormality might be connected with hyperplasia of megakaryocytes and thrombocythemia, as recently reported in patients with acute leukemia. In the initial phase of the disease our patient had also thrombocythemia, hyperplasia of megakaryocytes with morphological abnormalities. Furthermore, when blast cells were culture in diffusion chambers, differentiation into several cell lines occurred but not into megakaryopoiesis. It is, therefore, concluded that the involved band on chromosome No. 3 might contain the locus which controls megakaryocytic proliferation and platelet production but additional factors seem to be required for their expression.

Bone Marrow↗
PubMed1982

Assessment of bone marrow histology in Hodgkin's disease: correlation with clinical factors.

Bone marrow biopsies of 491 untreated and 170 treated patients with Hodgkin's disease (HD) were investigated. Marrow involvement was found in 10% and 25% respectively. Positive biopsies were rare in clinical stages I and II (1% and 2%), but the incidence rose to 25% and 45% in stages III and IV. HD patients with nodular sclerosis in lymph node histology had a low incidence of bone marrow involvement (4%), while those with lymphocytic depletion had a high incidence (22%). Of nine clinical and six histological parameters tested, bone marrow involvement proved to be the most significant predictive factor indicating an unfavourable course. Moreover, classification of the bone marrow manifestations according to the degree of lymphocytic infiltration, proved to be simple, reproducible and prognostically significant. Normal haematopoietic tissue was found in only 20% of the negative biopsies of untreated patients. The remaining 80% were characterized by a variety of non-specific reactions. These included marrow hypoplasia and leukaemoid and exudative reactions each of which indicated a poor prognosis; and epithelioid-cell granulomas and lymphoid nodules which predicted favourable survival curves. Adequate bone marrow biopsy is a valuable part of the investigation of patients with HD, as both positive and negative biopsies provide information of prognostic significance.

Adolescent↗
PubMed1982

Bone marrow histology in myeloma: its importance in diagnosis, prognosis, classification and staging.

A study has been made of 420 bone marrow biopsies from patients with multiple myeloma (220), idiopathic monoclonal gammapathy (50), reactive plasmacytosis (42) and solitary plasmacytoma (22). Histology and immunohistological parameters were more reliable than cytology in distinguishing a reactive from a neoplastic plasmacytosis. Histological variables were correlated with the clinical features of the patients to determine the factors which were of value in predicting prognosis. Plasma cell maturity and the extent of infiltration in the biopsy by myeloma cells proved to be highly significant in predicting the duration of survival. On the basis of these criteria multiple myeloma was classified into two types: plasmacytic of low-grade malignancy and plasmablastic of high-grade malignancy; and into three stages which accurately reflected the progression of the disease. We conclude that a bone biopsy provides useful information for the diagnosis, classification and staging of patients with multiple myeloma.

Bone Marrow↗
PubMed1982

Assessment of bone marrow histology in the malignant lymphomas (non-Hodgkin's): correlation with clinical factors for diagnosis, prognosis, classification and staging.

Bone marrow biopsies of 678 untreated patients with established malignant non-Hodgkin's lymphomas (ML) were investigated. The bone marrow was involved in 468 cases, an overall frequency of 69%. The Kiel classification of the ML (based on lymph node histology) was applied and the biopsies were classified: ML lymphocytic 36%, ML 'hairy cell' 24%, ML lymphoplasmacytic/cytoid 24%, ML centrocytic 6%, ML centroblastic/centrocytic 4%, ML lymphoblastic (without ALL) 3%, ML centroblastic 2% and ML immunoblastic 1%. The life tables of the patients were similar whether classified according to the histology of the lymph node or the bone marrow. A multivariate computer based analysis of both clinical and histological data was performed to test their prognostic relevance. The cell type, the proliferation pattern and the extent of infiltration in the bone marrow all proved to be factors of prognostic significance. The results indicate that classification of the ML based on lymph node histology is applicable to the bone marrow, is reproducible and has prognostic significance. Consequently, a bone marrow biopsy is a useful clinical tool for staging and for histological classification of patients with ML.

Bone Marrow↗
PubMed1982

Bone biopsy in haematological disorders.

Bone marrow biopsies are now widely used in the investigation and follow-up of many diseases. Semi-thin sections of 8216 undecalcified biopsies of patients with haematological disorders were studied. Observations were made on the cytopenias and the myelodysplastic syndromes, the acute leukaemias the myeloproliferative disorders, Hodgkin's disease and the malignant lymphomas including multiple myeloma, hairy cell leukaemia and angioimmunoblastic lymphadenopathy. Bone marrow biopsies are essential for the differential diagnosis of most cytopenias and for the early recognition of fibrosis which most frequently occurred as a consequence of megakaryocytic proliferation in the myeloproliferative disorders. Different patterns of bone marrow involvement were found in the lymphoproliferative disorders and both their type and extent constituted factors of prognostic significance. A survey of the literature is given and the conclusion is drawn that bone marrow biopsies provide indispensible information for the diagnostic evaluation and the follow-up of patients with haematological disorders.

Anemia↗
PubMed1982

Bone marrow biopsy in clinical medicine: an overview.

Bone marrow biopsies are now employed in the investigation of many disorders in haematology, oncology and internal medicine. This review provides a survey of the recent literature and a summary of observations made on undecalcified bone marrow biopsies embedded in plastic. The conditions investigated include osteopathies, myelopathies, haematologic and non-haematologic malignancies in the bone marrow. The interrelationship and interdependence of bone and bone marrow have been emphasized, and examples of the effects of diseases of bone on marrow, and of disturbancies of marrow function on bone, have been given. In the myelo- and lympho-proliferative disorders bone marrow biopsies contribute to diagnostic evaluation and classification, as well as to provide factors of prognostic significance. In the investigation of patients with solid tumours bone marrow biopsy may detect metastases in 20 per cent (bronchus), 35 per cent (prostate), 40 per cent (breast), to 80 per cent (unknown primaries) of the patients. Bone marrow biopsy constitutes an additional investigative parameter capable of providing valuable information in many different clinical situations.

Adolescent↗
PubMed1982

[Skin and bone findings in mastocytosis].

The syndrome of mastocytosis extends from cutaneous urticaria pigmentosa through systemic mastocytosis to the rarely occurring mast cell leukaemia. Our investigations with a large patient collective have shown that systemic forms of the disease occur more often than is generally supposed. In particular the incidence of bone marrow manifestations deserve more attention. The inflammatory-granulomatous findings in the bone marrow suggest an immunoactive component in the pathogenesis of this disease. The bone lesions that occur in about 50% of patients are probably the result of the common endosteal site of the mastocytosis granuloma. These lesions can be generalized (osteoporosis-osteosclerosis) or localized (osteolytic-osteosclerotic foci). In clinical practice bone biopsy and skeletal radiology complement one another; in addition to skin biopsy bone biopsy supplies the initial diagnosis of mastocytosis and documents systemic manifestation; the X-ray picture informs the clinician about the type and extent of the bone pathology.

Adolescent↗
PubMed1981

[Twelve theses on the pathogenesis of primary and secondary osteoporosis based on histological observations].

In spite of a well defined clinical syndrome and a wealth of biochemical information, the pathogenesis of primary osteoporosis is still uncertain. Microscopic evaluation of semithin sections of 1727 bone biopsies from patients suffering from "idiopathic" osteoporosis and 288 from patients with secondary osteoporosis has lead to the recognition of a pathogenetic relationship between changes of the bone marrow capillaries and atrophy of the trabecular bone in these groups. A new hypothesis is proposed for the structural and functional role of the bone marrow capillaries in normal and abnormal osseous remodelling; this is based on comparative morphometric analysis of normal cases and of hypo- and hyperplastic changes of the myelogenous and osseous tissues in various haematological and bone disorders. The hormonal and nervous regulation of the microcirculation of bone marrow may offer a new approach to the understanding and cure of so-called idiopathic osteoporosis.

Adult↗
PubMed1981

Detection of haematologic and nonhaematologic cancer by bone biopsy.

A retrospective study was carried out to test the efficacy of routine bone marrow biopsies for the diagnosis, classification, and prognosis of different forms of neoplastic involvement. Trephine and needle biopsies of the iliac crest of 3,626 patients with haematologic and 838 patients with nonhaematologic neoplasias were embedded without prior decalcification. 43 histologic variables were evaluated in 3-millimicrons sections of each biopsy, stained by five different techniques. The incidence of bone marrow involvement, in decreasing order of frequency, was as follows: plasmacytoma 55% and 95% of 428 cases, malignant lymphoma 37% and 79% of 1.112 cases, metastatic carcinoma 20% and 63% of 838 cases, and Hodgkin disease 3% and 28% of 772 cases each without and with manifest systemic dissemination. In the group of the metastatic carcinomas, there was a striking incidence of bone marrow involvement--82%--due to occult primary tumours. From a comparison of these figures with those reported in the literature, it is concluded that the large variations in positive and negative results are due to 1) differences in the size and the preparation of the specimens, 2) extent of the neoplastic dissemination at the time of the biopsy, and 3) the incidence of bone marrow involvement characteristic for a particular type of neoplasia. In addition, a subclassification of the chronic myeloproliferative disorders is proposed; it is based on histologic criteria whose prognostic relevance was tested and demonstrated by statistical analysis of the survival rates. The high incidence of detection reported in this study in patients without other evidence of systemic spread, or even in patients with occult neoplasias, provides a strong justification for the use of bone marrow biopsy as a primary diagnostic tool as well as a staging procedure, in both haematologic and nonhaematologic cancer.

Biopsy↗
PubMed1980

[Radiological and histological changes in the skeleton in systemic haematological diseases (author's transl)].

The findings at bone marrow biopsies in 5,000 patients with systemic haematological diseases were compared with the radiographic appearances. Haemoblastic conditions produce diffuse involvement of the bone marrow, whereas conditions characterised by limited infiltration, such as Waldenström's disease or Brill-Symmers' disease, produce some osteoporosis and only rarely bone destruction. Haemoblastic diseases with additional focal proliferation, such as myelofibrosis or myelosclerosis, multiple myeloma, highly malignant lymphomas and malignant granulomatosis produce circumscribed changes in the spongiosa which are readily recognised radiologically. In addition to generalised osteoporosis or sclerosis, one finds local areas of osteolysis or osteoplasia. Bone marrow biopsies in above-mentioned conditions indicate that they progress in a series of stages which correlate well with the radiological findings.

Bone Diseases↗