Reed–Sternberg cells detected in the bone marrow aspirate in a young patient with nodular sclerosis Hodgkin lymphoma

Abstract

A 19-yr-old Caucasian male presented with left neck lymphadenopathy and flu-like symptoms. A computer tomography (CT) scan of the neck demonstrated extensive left-sided cervical lymphadenopathy suggestive of lymphoproliferative disorder (Fig. 1A). An excisional biopsy was performed, and nodular sclerosis classical Hodgkin lymphoma was diagnosed based on histology features and positive staining of CD30, CD15, Pax5 and EBV. Laboratory investigations showed a pancytopenia with hemoglobin concentration 96 g/L, thrombocytopenia with platelet 92 9 10/L and neutropenia with a neutrophil count of 1.4 9 10/L. Due to the pancytopenia, bone marrow involvement was suspected, and a bone marrow staging was performed. Microscopic evaluation of bone marrow aspirate revealed trilineage hematopoiesis without dysplasia. In one location adjacent to a bone marrow particle, a giant binucleated Reed– Sternberg cell resembling an ‘OWL’s Eye’ appearance with prominent eosinophilic inclusion-like nucleoli (Fig. 1B) was observed. The Reed–Sternberg cell had a 3.5-fold diameter longer than an adjacent band with a bluish cytoplasmic hue and vacuolations. In the touch preparation film, another binucleated atypical Reed–Sternberg cell was found, suggesting a bone marrow involvement of the Hodgkin lymphoma. Bone marrow biopsy demonstrated normal marrow without fibrosis; further immunostaining with CD30, CD15, Pax5 and EBER was equivocal due to the small suboptimal size of the biopsy samplings. A repeat bone marrow biopsy request was declined by the patient. Based on the pancytopenia and patient’s conditions, a clinical diagnosis of stage 4 Hodgkin lymphoma was established. Patient received the standard chemotherapy for Hodgkin lymphoma, but was refractory to the treatment. An autologous bone marrow transplant was performed, but patient died of relapsed Hodgkin lymphoma 6 months post diagnosis. Reed–Sternberg cells are pathognomonic for classical Hodgkin lymphoma. They can be found in the tissue sampling of the bone marrow. Observation of Reed–Sternberg cells in the bone marrow aspirate is rare, possibly due to the fibrotic nature of the disease. But in certain age population especially children and young adult, Reed–Sternberg cells can be detected in the aspirate possible due to the less fibrotic young marrow. Thus, careful examination of bone marrow aspirate in young patients with known Hodgkin lymphoma can be useful in making the clinical decision as shown in this case. Financial support