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.

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Figure 2.

Immunohistochemistry analysis for CD30 is positive in Reed–Sternberg and Hodgkin cells (arrows). Bone marrow biopsy, 400 × magnification.

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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