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

Ja Young Lee; Jae Hyun Kim; Jeong Hwan Shin; Hye Ran Kim; Jeong Nyeo Lee; Ki Hyang Kim; Won Sik Lee; Young Don Joo; Chang Hak Sohn; Chan-Hwan Kim

doi:10.5045/kjh.2008.43.1.48

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Lee, Kim, Shin, Kim, Lee, Kim, Lee, Joo, Sohn, and Kim: Primary Isolated Bone Marrow Diffuse Large B-cell Lymphoma with Hemolytic Anemia as the First Manifestation

Case Report

Korean J Hematol 2008;43(1):48-52.

Published online: 19 March 2008

DOI: https://doi.org/10.5045/kjh.2008.43.1.48

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

Ja Young Lee, M.D.¹, Jae Hyun Kim, M.D.¹, Jeong Hwan Shin, M.D.¹, Hye Ran Kim, M.D.¹, Jeong Nyeo Lee, M.D.^1,, Ki Hyang Kim, M.D.², Won Sik Lee, M.D.², Young Don Joo, M.D.², Chang Hak Sohn, M.D.², Chan-Hwan Kim, M.D.³

¹Department of Laboratory Medicine, Busan, Korea

²Department of Hemato-oncology, Busan, Korea

³Pathology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea

Correspondence to：Jeong Nyeo Lee, M.D. Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University 633-165, Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea Tel: ＋82-51-890-6862, Fax: ＋82-51-893-1562 E-mail: jeong418@medimail.co.kr

Received 26 December 2007 Revised 5 February 2008 Accepted 15 February 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Diffuse large B-cell lymphoma, Bone marrow, Hemolytic anemia

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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).

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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