#00063542

A 56-year-old male presented with a 3 month history of anemia and jaundice. Investigations revealed pancytopenia with a hemoglobin of 54 g/L, leukocytes 3.55×10^9/L, platelets 70×10^9/L, and mean corpuscular volume 95 fL. He had no lymphadenopathy or organomegaly. There was indirect hyperbilirubinimia and elevated LDH. Markers of autoimmune hemolysis, Wilson disease and hemoglobinuria were negative. Bone marrow aspiration (BMA) with biopsy demonstrated a hypercellular marrow. Intertrabecular spaces are solid in foci and contain polymorphs, infiltrates of lymphocytes, histiocytes, eosinophils, and neutrophils admixed with few large binucleate cell with round nuclei, fine chromatin, and prominent nucleoli (RS cells) (Panel A). On Immuno-histochemistry of bone marrow biopsy tissue, large cells were positive for CD-30, CD-15, CD-20, PAX-5, Ki 67 (10%) and negative for CD-3 and EMA, which favored the diagnosis of classical Hodgkin lymphoma (HL) (Panel B-F).

Bone marrow involvement in HL is rare, and have average incidence of 10%. It is considered a sign of generalized disease and represents stage IV disease.  Clinical stages 1A and II A have less than 1% of patients with bone marrow involvement. BMA has no role in prognosis of disease in early stages, whereas patients presenting with cytopenias, elevated LDH and alkaline phosphatase have to be evaluated with BMA with trephine biopsy of adequate tissue (at least 2cm). There may be need to repeat BMA, because of focal or patchy involvement of marrow in HL.