Bone marrow involvement by classic Hodgkin lymphoma

[摘要] A 70-year-old male patient with a history of prostate cancer (Gleason score 7) treated with proton beam and Leuprolide presented withfatigue, fever, and new cytopenia (Hgb: 10.5 g/dL, RBC: 3.57 × 10 12/L,MCV: 94.1 fL, RDW: 17.8%,WBC: 5.4×10 9, Platelet: 104×10 9/L). CTscan showed periportal and retroperitoneal lymphadenopathy whilepositron emission tomography-computed tomographic scan showedasymmetric increased fluorodeoxyglucose uptake in the bone marrow.Review of the peripheral blood smear did not show any remarkablefindings; however, the bone marrow aspirate revealed the presenceof large atypical lymphoid cells with reticulated chromatin and prominent nucleoli (Top left, X100). Few cells were bilobed with prominentnucleoli and ample amount of cytoplasm (Top middle, ×100). The core biopsy revealed an atypical lymphohistiocytic infiltrate composed oflarge, atypical cells with irregular nuclear contours, prominent nucleoli,and abundant amount of cytoplasm, consistent with Reed–Sternbergcells (RS) and variants (Top right, ×60).