Lab Med Online.  2013 Apr;3(2):104-109.

A Case of Hepatosplenic T-cell Lymphoma Diagnosed by Bone Marrow Examination

• So HJ
• Lee JK
• Hong YJ
• Hong SI
• Kang HJ
• Lee SS
• Chang YH

Abstract

Hepatosplenic T-cell lymphoma (HSTL) is a condition in which lymphoma cells infiltrate the sinusoids of the liver, spleen, and bone marrow, without lymph node involvement. We encountered a case of hepatosplenic T-cell lymphoma in a Vietnamese woman. The patient was hospitalized with epigastric pain and nausea. Splenomegaly and multiple poorly defined, low-attenuating nodular lesions in the liver were visualized on computed tomography (CT), and thrombocytopenia was noted. The lymph nodes were not significantly enlarged. Splenic biopsy could not be performed because of severe thrombocytopenia. Neoplastic lymphoid cells were present in bone marrow aspirates. Bone marrow sections revealed infiltration of CD3(+) and CD20(-) neoplastic lymphoid cells in the sinusoids. A clonality assay (IdentiClone T-Cell Receptor Delta Gene Clonality Assay; Invivoscribe Technologies, USA) showed gene rearrangements in the T-cell receptor delta gene. Thus, we made a confirmatory diagnosis of HSTL. When splenic biopsy is not available, bone marrow aspirates and clonality assessment may become useful diagnostic tools.

Keyword

Hepatosplenic T-cell lymphoma; bone marrow examination; TCR gene rearrangement

MeSH Terms

Asian Continental Ancestry Group
Biopsy
Bone Marrow
Bone Marrow Examination
Female
Gene Rearrangement
Humans
Liver
Lymph Nodes
Lymphocytes
Lymphoma
Lymphoma, T-Cell
Nausea
Receptors, Antigen, T-Cell
Spleen
Splenomegaly
T-Lymphocytes
Thrombocytopenia
Receptors, Antigen, T-Cell

Figure

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  Fig. 1 Abdominal computed tomography (CT) scan showing splenomegaly and multiple poorly marginated nodules at diagnosis (A), and a slight decrease in splenomegaly can be noted after chemotherapy (B). (A) Initial CT scan showing splenomegaly. (B) Post-chemotherapy CT scan showing a slight decrease in splenomegaly.

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  Fig. 2 Bone marrow aspirates showing 13.2% neoplastic lymphoid cells at diagnosis (A; Wright stain, ×1,000). After chemotherapy, very few neoplastic cells remained (B).

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  Fig. 3 Hematoxylin and eosin (H&E) staining (A and C) and immunohistochemical staining for CD3 (B and D) in bone marrow biopsy specimens obtained before chemotherapy (A and B) and after chemotherapy (C and D). Magnification: ×400. (A) Bone marrow was infiltrated with a monotonous population of neoplastic lymphoid cells. (B) Immunohistochemical staining for CD3 highlights lymphoid cells within sinusoids. (C) Very few neoplastic lymphoid cells can be observed. (D) CD3-positive neoplastic lymphoid cells are almost absent.

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  Fig. 4 T-cell receptor (TCR) gene rearrangement results. Lane 1: 100 bp ladder; lane 2: specimen control size ladder; lanes 3 and 4: TCRG gene (V, J region). (A) Lane 8: TCRD gene before chemotherapy (V, D, J region). (B) Lane 5: TCRD gene after chemotherapy (V, D, J region).

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