Hematology Case 29
Hematology Case 29
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Presented By Dr Shehab Al-Hammadi - Dr Mohammad Moharram
Released on 01-04-2020Patient Data
Patient Data
36 year old female
Clinical Data
Clinical Data
Pancytopnea
Splenomegaly (with no focal lesion by ultrasound)
Enlarged right cervical lymph nodes, bilateral inguinal lymph nodes and bilateral axillary lymph nodes.
Irregular menses.
Mild rectal bleeding from hemorrhoids.
Related Laboratory Results
Related Laboratory Results
W.B.C. : 3.87 LOW ABNORMAL x10^3/uL [4-10]
HGB: 7.70 LOW ABNORMAL g/dL [12-15]
MCV: 86.90 NORMAL FL [83-101]
PLATELET : 12 PANIC X10^3/UL [150-450]
Peripheral Smear: Abnormal mononuclear cells are seen. (Pictures are not included).
Bone marrow aspirate & trephine biopsy are recommended (See Below)
LDH: 209 HIGH ABNORMAL U/L [98-192]
Normal RFT and LFT
VITAMIN B12 : 182.50 LOW ABNORMAL pg/mL [240-900]
FOLATE: 9.24 NORMAL nmol/L [7-30]
FERRITIN: 196.80 HIGH ABNORMAL ng/mL [13-150]
Provisional Diagnosis
Provisional Diagnosis
Leukemia Vs Lymphoma.
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
BONE MARROW ASPIRATE
B.M. Trephine ; H.& E.
Comment / Findings
Comment / Findings
Bone Marrow Aspirate smear:
Depressed myeloid and erytheroid series. Marked decrease in megakaryocytes.
Relative increase in plasma cells and lymphocytes.
Increased eosinophils and its precursors.
Presence of large mononuclear cells of plasma-cytoid features.
Large binucleated cells are rarely seen. Some of them resemble dysplatic plasma cells. They may show open chromatin and visible nucleoli.
Bone marrow trephine biopsy:
Normocellular bone marrow biopsy for age.
There is nodular infilteratiin by atypical mononuclear cells with large nuclei and promenent nucleoli (Reed- Sternberg cell) surrounded by mixed inflammatory cells and fibroblasts. These cells are positive for CD30, CD15 , CD20 and negative for LCA (CD45), CD34, and CD3. All bone marrow elements are decreased.
Cervical Lymph Node Biopsy: "Biopsy taken after Bone Marrow Reported"
Sections show an effaced lymph node architectue showing infiltration mainly by mononuclear large cells. These cells have abundant basophilic cytoplasm, mononuclei and prominent nucleoli. Binucleated cells also seen. The background shows small lymphocytes, histiocytes and few plasma cells and eosinophils.
LCA (CD45): Negative in the large cells. CD30: Positive in the large cells. CD15: Focally and weakly positive in the large cells. CD20: Positive in the large cells. Fascin: Positive in the large cells. (Pictures not included)
Final Diagnosis
Final Diagnosis
A case of Bone Marrow infiltration by Classic Hodgkin's Lymphoma.
Additional note
Additional note
Stage 4 Classic Hodgkin's Lymphoma
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