Examination of the bone marrow should include evaluation for the presence of fibrosis.
Stains on core biopsy required to assess reticulin and collagen:
(1) reticulin stain (silver impregnation)
(2) trichrome stain
Assessment:
(1) Reticulin is concentrated around blood vessels and close to bone trabeculae; these areas should be disregarded when evaluating reticulin deposition
(2) Biopsies from the iliac crest tend to show more reticulin fibers than biopsies from the sternum
(3) Collagen is identified on trichrome stain and in polarized light.
(4) Crush artifact may be misinterpreted as fibrosis on hematoxylin-eosin preparations.
|
Reticulin Fibers |
Thick Coarse Fibers |
Collagen Fibers (trichrome stain) |
Grade |
|
no reticulin fibers demonstrable |
none |
none |
0 |
|
occasional fine individual fibers and foci of a fine fiber network |
none |
none |
1 |
|
fine fiber network throughout most of the section |
none |
none |
2 |
|
diffuse network |
scattered |
none |
3 |
|
diffuse network |
common |
present |
4 |
|
Grade |
Interpretation |
|
0 or 1 |
normal |
|
2 |
can occasionally be seen in normal individuals |
|
3 |
reticulin fibrosis |
|
4 |
myelofibrosis |
Specialty: Hematology Oncology, Clinical Laboratory
