Letter to the Editor

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Blood Res 2016; 51(2):

Published online June 23, 2016

https://doi.org/10.5045/br.2016.51.2.144

© The Korean Society of Hematology

A rare case of diffuse large B cell lymphoma-associated hemophagocytic syndrome initially present in the bone marrow with a favorable clinical course

Sang Hyuk Park1*, Eun Yup Lee1, and Joo Seop Chung2

1Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

2Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Correspondence to : Sang Hyuk Park. Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. korailman-1@hanmail.net

Received: May 26, 2015; Revised: June 3, 2015; Accepted: June 18, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Fig. 1.

Bone marrow aspirates (A, B, Wright stain, ×400) and touch print (C, D, Wright stain, ×400). The bone marrow aspirates and touch print show normocellular marrow with infiltration of neoplastic lymphoid cells (20.0% of total nucleated cells, orange arrows). In addition, hemophagocytic histiocytes (11.0% of total nucleated cells, yellow arrows) were identified.


Fig. 2.

Bone marrow biopsy (A, hematoxylin and eosin stain, ×400) and immunohistiochemical staining results for CD3, CD20 and CD68 (B–D, ×400, respectively). The bone marrow biopsy shows normocellular marrow with diffuse infiltration of CD20-positive neoplastic lymphoid cells (orange arrows) accompanied by an increase of CD68-positive histiocytes with occasional hemophagocytosis (yellow arrows), indicating the presence of B-cell lymphoma associated with hemophagocytic histiocytosis.


  1. Usmani, GN, Woda, BA, Newburger, PE. Advances in understanding the pathogenesis of HLH. Br J Haematol, 2013;161;609-622.
    Pubmed
  2. Cheung, MM, Chan, JK, Lau, WH, et al. Primary non-Hodgkin's lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol, 1998;16;70-77.
    Pubmed
  3. Falini, B, Pileri, S, De Solas, I, et al. Peripheral T-cell lymphoma associated with hemophagocytic syndrome. Blood, 1990;75;434-444.
    Pubmed
  4. Florena, AM, Iannitto, E, Quintini, G, Franco, V. Bone marrow biopsy in hemophagocytic syndrome. Virchows Arch, 2002;441;335-344.
    Pubmed
  5. Shimazaki, C, Inaba, T, Shimura, K, et al. B-cell lymphoma associated with haemophagocytic syndrome: a clinical, immunological and cytogenetic study. Br J Haematol, 1999;104;672-679.
    Pubmed
  6. Han, AR, Lee, HR, Park, BB, et al. Lymphoma-associated hemophagocytic syndrome: clinical features and treatment outcome. Ann Hematol, 2007;86;493-498.
    Pubmed
  7. Sano, H, Kobayashi, R, Tanaka, J, et al. Risk factor analysis of non-Hodgkin lymphoma-associated haemophagocytic syndromes: a multicentre study. Br J Haematol, 2014;165;786-792.
    Pubmed
  8. Yeh, YM, Chang, KC, Chen, YP, et al. Large B cell lymphoma presenting initially in bone marrow, liver and spleen: an aggressive entity associated frequently with haemophagocytic syndrome. Histopathology, 2010;57;785-795.
    Pubmed
  9. Jordan, MB, Filipovich, AH. Hematopoietic cell transplantation for hemophagocytic lymphohistiocytosis: a journey of a thousand miles begins with a single (big) step. Bone Marrow Transplant, 2008;42;433-437.
    Pubmed

Article

Letter to the Editor

Blood Res 2016; 51(2): 144-147

Published online June 23, 2016 https://doi.org/10.5045/br.2016.51.2.144

Copyright © The Korean Society of Hematology.

A rare case of diffuse large B cell lymphoma-associated hemophagocytic syndrome initially present in the bone marrow with a favorable clinical course

Sang Hyuk Park1*, Eun Yup Lee1, and Joo Seop Chung2

1Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

2Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.

Correspondence to: Sang Hyuk Park. Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. korailman-1@hanmail.net

Received: May 26, 2015; Revised: June 3, 2015; Accepted: June 18, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Fig 1.

    Figure 1.

    Bone marrow aspirates (A, B, Wright stain, ×400) and touch print (C, D, Wright stain, ×400). The bone marrow aspirates and touch print show normocellular marrow with infiltration of neoplastic lymphoid cells (20.0% of total nucleated cells, orange arrows). In addition, hemophagocytic histiocytes (11.0% of total nucleated cells, yellow arrows) were identified.

    Blood Research 2016; 51: 144-147https://doi.org/10.5045/br.2016.51.2.144

    Fig 2.

    Figure 2.

    Bone marrow biopsy (A, hematoxylin and eosin stain, ×400) and immunohistiochemical staining results for CD3, CD20 and CD68 (B–D, ×400, respectively). The bone marrow biopsy shows normocellular marrow with diffuse infiltration of CD20-positive neoplastic lymphoid cells (orange arrows) accompanied by an increase of CD68-positive histiocytes with occasional hemophagocytosis (yellow arrows), indicating the presence of B-cell lymphoma associated with hemophagocytic histiocytosis.

    Blood Research 2016; 51: 144-147https://doi.org/10.5045/br.2016.51.2.144

    References

    1. Usmani, GN, Woda, BA, Newburger, PE. Advances in understanding the pathogenesis of HLH. Br J Haematol, 2013;161;609-622.
      Pubmed
    2. Cheung, MM, Chan, JK, Lau, WH, et al. Primary non-Hodgkin's lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol, 1998;16;70-77.
      Pubmed
    3. Falini, B, Pileri, S, De Solas, I, et al. Peripheral T-cell lymphoma associated with hemophagocytic syndrome. Blood, 1990;75;434-444.
      Pubmed
    4. Florena, AM, Iannitto, E, Quintini, G, Franco, V. Bone marrow biopsy in hemophagocytic syndrome. Virchows Arch, 2002;441;335-344.
      Pubmed
    5. Shimazaki, C, Inaba, T, Shimura, K, et al. B-cell lymphoma associated with haemophagocytic syndrome: a clinical, immunological and cytogenetic study. Br J Haematol, 1999;104;672-679.
      Pubmed
    6. Han, AR, Lee, HR, Park, BB, et al. Lymphoma-associated hemophagocytic syndrome: clinical features and treatment outcome. Ann Hematol, 2007;86;493-498.
      Pubmed
    7. Sano, H, Kobayashi, R, Tanaka, J, et al. Risk factor analysis of non-Hodgkin lymphoma-associated haemophagocytic syndromes: a multicentre study. Br J Haematol, 2014;165;786-792.
      Pubmed
    8. Yeh, YM, Chang, KC, Chen, YP, et al. Large B cell lymphoma presenting initially in bone marrow, liver and spleen: an aggressive entity associated frequently with haemophagocytic syndrome. Histopathology, 2010;57;785-795.
      Pubmed
    9. Jordan, MB, Filipovich, AH. Hematopoietic cell transplantation for hemophagocytic lymphohistiocytosis: a journey of a thousand miles begins with a single (big) step. Bone Marrow Transplant, 2008;42;433-437.
      Pubmed
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