A 78-year-old man was referred for evaluation of severe anemia (hemoglobin concentration 6.7 g/dL) and thrombocytopenia (8 × 109 /L), bilateral axillary adenomegaly, and massive hepatosplenomegaly. Bone marrow aspirate revealed trilineage hematopoiesis and the presence of giant bilobed nucleus cells with prominent eosinophilic inclusion-like nucleoli surrounded by lymphocytes (rosetting formation) and large mononuclear cells, resembling Reed-Sternberg and Hodgkin cells, respectively (Figure 1). Axillary lymph node biopsy confirmed classical Hodgkin lymphoma (cHL) diagnosis (CD15+, CD30+, CD20-, CD45-). Bone marrow infiltration by cHL was confirmed by biopsy (Figure 2).
(A) Reed-Sternberg Cell. Large cell surrounded by multiple lymphocytes in a rosetting formation. (B) Hodgkin Cell. Atypical mononuclear cell flanked by some lymphocytes. Bone marrow aspirate, Leishman stain, 1000 × magnification.
Immunohistochemistry analysis for CD30 is positive in Reed-Sternberg and Hodgkin cells (arrows). Bone marrow biopsy, 400 × magnification.
Detection of cHL tumor cells in the bone marrow aspirate is uncommon, possibly due to scattered focal lesions and the fibrotic nature of the disease.11 Xu Zhaodong, B.F. Burns, C. FaughtReed-Sternberg cells detected in the bone marrow aspirate in a young patient with nodular sclerosis Hodgkin lymphoma. Eur J Haematol, 2014;92(4):365-6. doi: 10.1111/ejh.12180.
https://doi.org/10.1111/ejh.12180...
,22 S.G. Lee, S.Y. Paik, H.J. Sohn, S.Y. Kim, S.Y. KongNumerous reed-sternberg cells in bone marrow aspirate from a patient with the syncytial variant of nodular sclerosis classical Hodgkin lymphoma. Int J Hematol, 2015;101(2):107-8. doi: 10.1007/s12185-014-1727-3.
https://doi.org/10.1007/s12185-014-1727-...
Multiple tumor-infiltrating T cells in rosetting arrangement suggest an ineffective T cell response against cHL.33 S. Vardhana, A. YounesThe immune microenvironment in Hodgkin lymphoma: t cells, B cells, and immune checkpoints. Haematologica, 2016;101(7):794-802. doi: 10.3324/haematol.2015.132761.
https://doi.org/10.3324/haematol.2015.13...
References
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1Xu Zhaodong, B.F. Burns, C. FaughtReed-Sternberg cells detected in the bone marrow aspirate in a young patient with nodular sclerosis Hodgkin lymphoma. Eur J Haematol, 2014;92(4):365-6. doi: 10.1111/ejh.12180.
» https://doi.org/10.1111/ejh.12180 -
2S.G. Lee, S.Y. Paik, H.J. Sohn, S.Y. Kim, S.Y. KongNumerous reed-sternberg cells in bone marrow aspirate from a patient with the syncytial variant of nodular sclerosis classical Hodgkin lymphoma. Int J Hematol, 2015;101(2):107-8. doi: 10.1007/s12185-014-1727-3.
» https://doi.org/10.1007/s12185-014-1727-3 -
3S. Vardhana, A. YounesThe immune microenvironment in Hodgkin lymphoma: t cells, B cells, and immune checkpoints. Haematologica, 2016;101(7):794-802. doi: 10.3324/haematol.2015.132761.
» https://doi.org/10.3324/haematol.2015.132761
Publication Dates
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Publication in this collection
10 June 2022 -
Date of issue
2022
History
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Received
19 Dec 2020 -
Accepted
02 Feb 2021 -
Published
21 Apr 2021