Significance of Sudan Black-B Staining in Identifying Lymphoma Infiltration of Bone Marrow

Abstract

Background.In lymphoma infiltrations there in not only prominence of lymphocytes in the marrow but cells
with an atypical morphology are also commonly seen. These lymphoma cells are difficult to differentiate
morphologically from those of myeloid series. Cytochemcial staining has been used in diagnosis of acute
leukemias for more than 20 years. However, value of Sudan Black-B (SBB) stain in the detection of
lymphoma cells has not yet been elucidated. This stain differentiates lymphocytic proliferations from the
non-lymphocytic ones.
Methods. Eighty cases of lymphoma diagnosed on lymph node biopsy were included in this study. Bone
marrow aspiration, clot and trephine biopsy along with complete blood counts were performed in all these
cases.
Results. Out of 25 case of Hodgkin Disease (HD), 22 cases (88 %) did not show evidence of infiltration
when stained with Giemsa and 3 were positive for infiltration (12 %). SBB showed negatively stained
atypical lymphocytes in 5 (20 %) cases whereas 20 (80 %) patients showed no such evidence in their
marrow aspirates. The positive yield rose to 6 (24%) patients when their trephine biopsies were stained with
H and E stain. Out of 55 case of Non- Hodgkin Lymphoma (NHL), 15 (27.3 %) showed infiltration on Giemsa
stain, while on SBB stain atypical lymphocytes were noted in 20 (36.4 %) cases. Trephine biopsies of these
patients showed infiltrates in 32 (58.2 %) cases.
Conclusion. Identification of positive cases becomes easier Sudan Black B Staining. It is as good as
trephine biopsy. In cases where trephine biopsy is not possible, staining with SBB can be of additional
diagnostic value for assessing extent of infiltration in both HD & NHL.