Reed-Sternberg and Hodgkin cells in bone marrow aspirate from a classical Hodgkin lymphoma patient

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).

Figure 1
(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.

Figure 2
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.¹,² Multiple tumor-infiltrating T cells in rosetting arrangement suggest an ineffective T cell response against cHL.³

References

• ¹
  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
• ²
  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/s12185-014-1727-3
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  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.2015.132761

Publication Dates

• Publication in this collection
  10 June 2022
• Date of issue
  2022

History

• Received
  19 Dec 2020
• Accepted
  02 Feb 2021
• Published
  21 Apr 2021