Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 13, Number 9, September 2022, pages 427-431

Immunocompetent Patient With Primary Bone Marrow Hodgkin Lymphoma

Figures

Figure 1.
Figure 1. CT abdomen/pelvis demonstrated a small hypoattenuating lesion in the liver, measuring up to 7 mm. CT: computed tomography.
Figure 2.
Figure 2. Bone marrow aspiration immunohistochemistry stains and in situ hybridization (ISH) stains. (a) Low power (× 20 magnification) hematoxylin and eosin stain of bone marrow aspirate clot shows marrow particles with Reed-Sternberg (RS) cells having prominent nucleoli and occasional bilobed forms (arrows) in a background of mixed mature and immature hematopoietic cells. (b) Photomicrograph (× 30 magnification) depicting CD 30+ immunohistochemistry (IHC) shows membranous and Golgi staining in RS cells. (c) Photomicrograph (× 30 magnification) depicting CD15+ IHC shows membranous and Golgi staining in the RS cells too, along with the staining of background granulocytes. (d) Photomicrograph (× 30 magnification) depicting PAX 5+ IHC shows positive staining in RS cells (lighter staining) and background B lymphocytes (darker staining). (e) Photomicrograph (× 30 magnification) depicting EBER ISH shows nuclear staining in RS cells, indicating Epstein-Barr virus (EBV) positivity (photomicrographs credit to Mary Hansen Smith, MD, Department of Pathology, Banner University Medical Center, Tucson, Arizona).

Table

Table 1. Reported Cases in Literatures of Isolated Bone Marrow Involvement in HIV-Negative Adults
 
AgeSex, ethnicityPresenting symptomsTreatmentResponse and reported survival from diagnosisTime from symptoms to diagnosis (months)Bone marrow pathology
Amount of RS cellsBackground
ABVD: doxorubicin (adriamycin), bleomycin, vinblastine, and dacarbazine; AVD: doxorubicin, vinblastine, dacarbazine; COD: cyclophosphamide, vincristine, and dexamethasone; RS: Reed-Sternberg; NA: not obtained.
66 [10]Female, CaucasianFever, chills, cytopeniaABVD (one cycle) and AVD (five cycles)Complete remission 15+ months4ScatteredEosinophils, small mature lymphocytes
64 [11]MaleFever, chills, cytopeniaABVD (one cycle)No remission < 1 month6OccasionalLymphohistiocytic cells, eosinophils
50 [12]Male, AfricanFevers, cytopeniaABVD (on first cycle)No remission 3 weeks6ScatteredLymphocytes
68 [13]MaleFevers, cytopeniaNot doneNo remission 2 months2ScatteredLymphocytes
38 [14]FemaleFevers, cytopeniaABVD (six rounds)Hematologic remissionNANANA
70 [15]MaleAnemia, malaiseNANANAOccasionalSmall lymphocytes, neutrophils, eosinophils and histiocytes
51 (this case)Female, AfricanGeneralized myalgias, fatigue and feversCOD (one cycle)No remission 1 month2OccasionalLymphohistiocytes, eosinophils