Korean J Hematol.  2008 Mar;43(1):48-52. 10.5045/kjh.2008.43.1.48.

Primary Isolated Bone Marrow Diffuse Large B-cell Lymphoma with Hemolytic Anemia as the First Manifestation

• Lee JY
• Kim JH
• Shin JH
• Kim HR
• Lee JN
• Kim KH
• Lee WS
• Joo YD
• Sohn CH
• Kim CH

• KMID: 1485157
• DOI: http://doi.org/10.5045/kjh.2008.43.1.48

Abstract

Primary isolated bone marrow disease as a presenting feature of diffuse large B-cell lymphoma is very rare. We describe the first Korean case of isolated bone marrow diffuse large B-cell lymphoma with hemolytic anemia as the first manifestation. A32-year-old man was admitted to our hospital presenting with fever and hematuria. He had severe anemia and high lactate dehydrogenase activity. His peripheral blood smear and laboratory findings were suggestive of intravascular hemolytic anemia. The bone marrow biopsy revealed involvement with diffuse large B-cell lymphoma. A computed tomographic scan showed splenomegaly, but no lymphadenopathy. Our case shared some clinical features with the Asian variant of intravascular B-cell lymphoma, but there was infrequent involvement of the sinusoids of lymphoma cells and no hemophagocytosis. Our patient was treated with R-CHOP regimen for six cycles and he is in remission after autologous peripheral blood stem cell transplantation.

Keyword

Diffuse large B-cell lymphoma; Bone marrow; Hemolytic anemia

MeSH Terms

Anemia
Anemia, Hemolytic
Asian Continental Ancestry Group
B-Lymphocytes
Biopsy
Bone Marrow
Bone Marrow Diseases
Fever
Hematuria
Humans
L-Lactate Dehydrogenase
Lymphatic Diseases
Lymphoma
Lymphoma, B-Cell
Peripheral Blood Stem Cell Transplantation
Splenomegaly
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1 Histologic features of diffuse large B cell lymphoma in the bone marrow. (A) Atypical large lymphoma cells are diffusely infiltrated (H&E stain, original magnification ×200). (B) Higher power view shows a diffuse lymphoid infiltrate with typical morphologic features of diffuse large B-cell lymphoma (H&E stain, original magnification ×400).

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  Fig. 2 Immunohistochemical stain of the bone marrow. (A) Lymphoma cells are positive for CD20 (original magnification ×400). (B) Lymphoma cells are negative for CD3 (original magnification ×400).

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