Clinically unsuspected Hodgkin′s lymphoma diagnosed primarily from bone marrow trephine biopsy: Report of six cases

Abstract

Bone marrow may be the initial or rarely the only site of involvement in Hodgkin′s lymphoma. A high index of suspicion is required to pick up the histopathological changes of Hodgkin′s lesions in the bone marrow like necrosis, presence of Reed-Sternberg cell or its variant in a polymorphic background infiltrate, focal fibrosis and myxoid change especially in the absence of classical clinical picture. Bone marrow with immunohistochemistry has a valuable role in the staging and in the diagnosis of primary medullary Hodgkin′s lymphoma. B-symptoms may easily masquerade as an infectious process as in all our cases the patients had fever as a presenting feature, in four of them tuberculosis was suspected clinically and two had received antitubercular therapy elsewhere. We report six human immunodeficiency virus-negative patients diagnosed over a period of 5 years in which the initial diagnosis of Hodgkin′s lymphoma was suggested from bone marrow histology.

Keywords

• Bone marrow
• Hodgkin′s lymphoma
• trephine biopsy