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<p>A 60 year old man with a history of treated pulmonary tuberculosis and type 2 diabetes mellitus presented with intermittent fever, fatigue, and significant weight loss (~15%) for 8–9 months. Hematologic evaluation revealed pancytopenia with hemoglobin 65 g/L, total leukocyte count 3.6 × 10⁹/L, and platelet count of 140 × 10⁹/L. Peripheral smear showed normocytic normochromic anemia without circulating blasts. Erythrocyte sedimentation rate was elevated (62 mm/hour), while liver andrenal function tests and viral serology were unremarkable. Contrast-enhanced CT enterography revealed multiple enlarged retroperitoneal lymph nodes without palpable peripheral lymphadenopathy. Bone marrow aspirate was hemodiluted; however, the biopsy was hypercellular and demonstrated scattered large atypical mononuclear and binucleated cells morphologically resembling Reed–Sternberg cells, with occasional ill-formed granulomas. Immunohistochemistry showed positivity for CD30, CD15, and weak PAX5, and negativity for CD45 and CD20, consistent with classical Hodgkin lymphoma involving bone marrow. The patient deteriorated rapidly and succumbed before lymph node biopsy could be performed.</p>

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Primary Diagnosis of Hodgkin Lymphoma on Bone Marrow Examination

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Nagarjun Sai Jaine,
  • Rajiv Tangri

摘要

A 60 year old man with a history of treated pulmonary tuberculosis and type 2 diabetes mellitus presented with intermittent fever, fatigue, and significant weight loss (~15%) for 8–9 months. Hematologic evaluation revealed pancytopenia with hemoglobin 65 g/L, total leukocyte count 3.6 × 10⁹/L, and platelet count of 140 × 10⁹/L. Peripheral smear showed normocytic normochromic anemia without circulating blasts. Erythrocyte sedimentation rate was elevated (62 mm/hour), while liver andrenal function tests and viral serology were unremarkable. Contrast-enhanced CT enterography revealed multiple enlarged retroperitoneal lymph nodes without palpable peripheral lymphadenopathy. Bone marrow aspirate was hemodiluted; however, the biopsy was hypercellular and demonstrated scattered large atypical mononuclear and binucleated cells morphologically resembling Reed–Sternberg cells, with occasional ill-formed granulomas. Immunohistochemistry showed positivity for CD30, CD15, and weak PAX5, and negativity for CD45 and CD20, consistent with classical Hodgkin lymphoma involving bone marrow. The patient deteriorated rapidly and succumbed before lymph node biopsy could be performed.