CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Pitfalls in bone marrow evaluation: Importance of adequate bone marrow sampling
Provisionally accepted
- UC Davis Medical Center, Sacramento, United States
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Bone marrow evaluation is a powerful diagnostic tool but comes with several potential pitfalls. These include issues related to sampling errors, technical challenges during processing, and misinterpretation of the findings due to similarities between various diseases. Awareness of these pitfalls, adopting a systematic approach of reviewing the bone marrow samples, and carefully integrating clinical information are critical to ensuring accurate diagnosis. Using ancillary techniques, such as immunohistochemistry (IHC), can further aid in distinguishing between benign reactive changes and malignant processes, reducing the likelihood of diagnostic errors. Bone marrow sampling is inherently challenging, and improper or inadequate sampling is one of the most common reasons for diagnostic failure. Moreover, process of collecting and preparing the bone marrow sample leading to aspicular aspirate smears with hemodilution or tissue preparation techniques like decalcification procedures in the core biopsy, leading to IHC stain failures may add to the diagnostic challenges in bone marrow evaluation. Lastly, inherent properties of some diseases or the presentation of abnormal findings with focal involvement or obscuring of morphology in an inflammatory background can pose a potential diagnostic challenge. In this article, we present three diagnostically challenging cases that highlight potential pitfalls in bone marrow evaluation along with a brief review of literature and describing strategies to avoid diagnostic errors based on our institutional experience.
Keywords: Bone Marrow, Lymphoma, Pitfall, Mantle cell lymphoma, Lymphoplasmacytic lymphoma, Classic Hodgkin lymphoma
Received: 13 May 2025; Accepted: 07 Nov 2025.
Copyright: © 2025 Ghezavati, Vali Betts and Datta Mitra. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ananya Datta Mitra, adattamitra@ucdavis.edu
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