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

Hee Jin So; Jin Kyung Lee; Young Jun Hong; Seok-Il Hong; Hye Jin Kang; Seung-Sook Lee; Yoon Hwan Chang

doi:10.3343/lmo.2013.3.2.104

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So, Lee, Hong, Hong, Kang, Lee, and Chang: A Case of Hepatosplenic T-cell Lymphoma Diagnosed by Bone Marrow Examination

Case Report

Diagnostic Hematology

Laboratory Medicine Online

Laboratory Medicine Online 2013; 3(2): 104-109.

Published online: 1 April 2013

DOI: https://doi.org/10.3343/lmo.2013.3.2.104

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

Hee Jin So, M.D.¹, Jin Kyung Lee, M.D.¹, Young Jun Hong, M.D.¹, Seok-Il Hong, M.D.¹, Hye Jin Kang, M.D.², Seung-Sook Lee, M.D.³, Yoon Hwan Chang, M.D.¹

¹Department of Laboratory Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

²Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

³Department of Pathology, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

Corresponding author: Yoon Hwan Chang, M.D. Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, 75 Nowon-ro, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-970-2492, Fax: +82-2-973-7143, hicyh@paran.com

Received 17 July 2012 Revised 3 August 2012 Accepted 10 August 2012

(open-access):

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

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.

Keywords: Hepatosplenic T-cell lymphoma, bone marrow examination, TCR gene rearrangement

Figures and Tables

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.

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).

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.

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).

Table 1

Clinical and laboratory characteristics of reported hepatosplenic T-cell lymphoma patients in Korea

^*Vietnamese; IProportion of neoplastic lymphoid cells in bone marrow.

Abbreviations: LNE, lymph node enlargement; LD, lactate dehydrogenase; LUQ, left upper quadrant; BM, bone marrow; NT, not tested; CHOP, cyclophosphamide, adriamycin, vincristine, prednisone; MTX, methotrexate; CVAD, cyclophosphamide, vincristine, doxorubicin, and dexamethasone; C, cytarabine; CR, complete remission.

Notes

This article is available from http://www.labmedonline.org

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