Hodgkin lymphoma (HL) is primarily a nodal disease with marrow involvement seen in 5% cases. As the bone marrow lacks lymphatics, marrow infiltration indicates vascular dissemination of the disease (Stage IV) [1]. The detection of Hodgkin/Reed-Sternberg (HRS) cells in peripheral blood is an exceptionally rare event with very few reported cases in literature [2].
A 20 years old woman diagnosed of classical HL with bone marrow involvement (Fig. 1a–d). presented with pancytopenia (Hb 4.96 mmol/L, TLC 2.2 ×109/L, Platelet count 30 ×109/L). Her peripheral blood smear showed few (2%) mononuclear and binuclear large cells with abundant basophilic cytoplasm and prominent nucleoli (Fig. 2a, b). This was a consistent finding on separate blood samples of the patient on different days. A cell block was prepared from the buffy coat preparation of the peripheral blood. Section from cell block was stained with Hematoxylin and eosin (H&E). It showed the presence of large cells (Fig. 2c). Immunohistochemistry was performed on cell block section. The large cells expressed CD30, CD15 and PAX5 (weak nuclear) but did not express CD20 and CD2 (Fig. 2d–f). Hence, the presence of HRS cells in her peripheral blood was confirmed.
Fig. 1.
a Bone marrow trephine biopsy section showing infiltration of marrow spaces by HRS cells (H&E, ×100); b High power view showing mononuclear and multinucleate HRS cells with prominent nucleoli and abundant cytoplasm (yellow arrows) (H&E, ×400); c HRS cells are positive for CD30 in membranous and Golgi region (IHC, ×400) d HRS cells are negative for CD20 (blue arrow) whereas surrounding B lymphocytes express CD20 (IHC, ×400). HRS Hodgkin/Reed-Sternberg cells; H&E Hematoxylin & eosin; CD Cluster of differentiation; IHC Immunohistochemistry
Fig. 2.
a, b HRS cells in peripheral blood smear (Wright stain, ×1000); c Section from cell block showing large cells with prominent nucleoli (blue arrows) (H&E, ×40); d These cells express CD30 (IHC, ×400; Inset ×1000); e Expression of CD15 (IHC, ×400) and expression of weak nuclear PAX5 (IHC, ×400). HRS hodgkin/reed-sternberg cells; H&E hematoxylin & eosin; CD cluster of differentiation; IHC immunohistochemistry; PAX5 Member of paired box family of transcription factors 5
Acknowledgement
We acknowledge all the technical staffs of hematology, histopathology and immunoheamatology laboratory in our department for their material support.
Abbreviations
- TLC
Total leucocyte count
- CD
Cluster of differentiation
- PAX5
Member of paired box family of transcription factors 5
Authors’ Contributions
Dr. Sanjiban Patra designed the concept, searched the literature, and prepared the manuscript. Dr Sunitha S searched the literature, helped in manuscript writing and revision. Dr Kanawalpreet Kaur searched the literature and helped manuscript revision. Dr Jyoti Sawhney revised the manuscript.
Declarations
Conflict of interest
The authors have no conflicts of interest to declare that are relevant to the content of this article.
Informed Consent
Informed consent has taken from the patient to publish her data and reports.
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Informed consent has been signed by the patient to publish her data and investigation reports.
Footnotes
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Contributor Information
Sanjiban Patra, Email: drsanjibanpatra84@gmail.com.
Sunitha Shankaralingappa, Email: sunithakiran84@gmail.com.
Kanwalpreet Kaur, Email: kanwalpreet.15@gmail.com.
Jyoti Sawhney, Email: Jyoti.sawhney@gcriindia.org.
References
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