Korean J Lab Med.  2007 Jun;27(3):182-187. 10.3343/kjlm.2007.27.3.182.

Bone Marrow Fibrin-Ring Granuloma: Review of 24 Cases

• Chung HJ
• Chi HS
• Cho YU
• Jang S
• Park CJ

• KMID: 1781481
• DOI: http://doi.org/10.3343/kjlm.2007.27.3.182

Abstract

BACKGROUND: Fibrin-ring granuloma (FRG), which can be found in bone marrow or the liver, is a subtype of epithelioid granuloma characterized by a central fat vacuole and annular peripheral fibrinoid materials. FRG has been proven to be associated with many etiologies such as several infectious organisms (Coxiella burnett; Epstein-Barr Virus, EBV; cytomegalovirus, CMV; and hepatitis A virus), allopurinol induced hepatitis, Hodgkin's lymphoma, and peripheral T-cell lymphoma. METHODS: We retrospectively reviewed 24 patients diagnosed with FRG by bone marrow biopsy at a single institute between 1995 and 2004. We reviewed clinical symptoms and laboratory findings of the patients, classified them by etiology, and compared prognosis of each group. RESULTS: The most common cause of FRG was acute or chronic EBV infection. Chronic or acute EBV infection was associated with 41.4% of patients (10/24). Of the remaining patients, 33.3% (8/24) were leukemia or lymphoma patients after chemotherapy, 4.2% (1/24) was a patient with hepatic failure, and 20.8% (5/24) were diagnosed as fever of unknown origin. The most common symptom and clinical finding were fever and cytopenia. EBV-associated group comprised chronic active EBV infection, EBV-associated hemophagocytic histiocytosis, acute EBV infection, EBV-associated lymphoproliferative disease, and Langerhans' cell histiocytosis. The EBV-associated group showed a lower survival probability compared with the non-EBV group (P<0.05). CONCLUSIONS: Patients with bone marrow fibrin ring granuloma accompanied by fever require an active workup to find out the cause of infectious agents including EBV infection particularly due to their poor prognosis.

Keyword

Epstein-Barr virus (EBV); Bone marrow; Fibrin-ring granuloma

MeSH Terms

Adolescent
Adult
Aged
Bone Marrow Diseases/diagnosis/*etiology/pathology
Child
Child, Preschool
Epstein-Barr Virus Infections/*complications/diagnosis
Female
Fibrin/analysis
Granuloma/diagnosis/*etiology/pathology
Herpesvirus 4, Human/immunology/isolation & purification
Humans
In Situ Hybridization
Male
Middle Aged
Polymerase Chain Reaction
Prognosis
Q Fever/diagnosis
Retrospective Studies
Survival Rate

Figure

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  Fig. 1. (A) Multiple fibrin-ring granulomas in UPN 5 (BM clot section, Hematoxylin-Eosin stain, ×400). EBV PCR with BM sample revealed positive. (B) Fibrin-ring granulomas in UPN 10. Serial result of real-time EBV quantitative PCR presented 15,720 copies/mL at the diagnosis of FRG and decreased to 2,490 copies/mL after 10 days (BM biopsy specimen, Hematoxylin-Eosin stain, ×400). (C) Masson's trichrome stain of fibrin-ring granulomas in UPN 10 (BM biopsy specimen, trichrome stain, ×400).

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  Fig. 2. Kaplan-Meier survival curves of patients. EBV positive group shows a significantly low survival rate. The median survival of EBV positive group is 1.4 months (mean=2.0 months) and that of negative group is 11.8 months (mean=50.7 months). Abbreviation: UPN, unique patient number.

Reference

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