169 A Rare Presentation of Hodgkin Lymphoma With Bone Marrow Phagocytized Neutrophil Fragments and Absence of Reed Sternberg Immunohistological Identification: A Case Report. (11th January 2018)

• Record Type: Journal Article
• Authors: Matloob, Ammar; Shi, Wenjing; Singh, Kunwar; Sharabi, Abdelsalam
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S72
• Page End: S72
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx121.168
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Phagocytic histiocytes are a type of cell that function as a part of the immune system. When these cells are overreacted, their distinct morphologies characterized by the engulfed cells within their cytoplasm may suggest a special disease such as hemophagocytic lymphohistiocytosis or Rosai-Dorfman disease, even associated with an underlying malignancy. Few studies have been reported that histiocytes containing predominantly fragments of neutrophil nuclei are associated with Hodgkin lymphoma (HL), one of the common lymphoma featured by Reed-Sternberg (RS) cells or variants. One study recently suggested that this phagocytized neutrophil phenomena of histiocytes in staging bone marrow biopsy were highly associated with underlying HL in children with 82.4% sensitivity and 81.0% specificity. Here, we report an adult case with a diagnosis of classic HL showing exuberant phagocytized neutrophils in the bone marrow staging sample even though HL histomorphology was absent in the bone marrow. A 40-year-old man presented with fatigue and weight loss over four months. An enlarged left neck lymph node with high uptake on PET-CT scan was noted. A lymph node biopsy showed classic HL, nodular sclerosing type, with large Reed-Sternberg (RS) cells showing prominent nuclei in the background of mixed small lymphocyte, plasma cells, and eosinophils. Positive immunostains for CD30 and PAX5, but negative for CD20, and in situ Epstein-Barr virus expression confirmed the diagnosis. Subsequent bone marrow biopsy for staging showed a hypercellular bone marrow with trilineage hematopoiesis. Marked increase in histiocytes with cytoplasmic phagocytized neutrophil fragments was readily noted throughout the specimen, confirmed by CD68 and CD163. No RS cells were identified in the bone marrow specimen both histologically and immunohistochemically. Consistent with the previous study result, our case further emphasizes that the unique morphological pattern of histiocytes with engulfed neutrophils in bone marrow samples has a potential clue to the underlying malignancy, particularly HL.