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Nagaharu K, Masuya M, Kageyama Y, Yamaguchi T, Ito R, Kawakami K, Ito M, Katayama N. Successful treatment of primary bone marrow Hodgkin lymphoma with brentuximab vedotin: a case report and review of the literature. J Med Case Rep 2018; 12:151. [PMID: 29843820 PMCID: PMC5975584 DOI: 10.1186/s13256-018-1693-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/17/2018] [Indexed: 12/27/2022] Open
Abstract
Background Hodgkin lymphoma usually presents with sequential enlargement of peripheral lymph nodes, and bone marrow invasion rarely occurs (approximately 3–5%). However, several cases have been reported as “primary” bone marrow Hodgkin lymphoma, especially among patients with human immunodeficiency virus and the elderly. This type of Hodgkin lymphoma is characterized by no peripheral lymphadenopathies and has been reported to have poorer prognosis. Case presentation A 38-year-old Japanese man was admitted to our hospital because of fever of unknown origin and pancytopenia without lymphadenopathies. Bone marrow examination revealed Hodgkin cells mimicking abnormal cells. These were positive for CD30, EBER-1, CD15, PAX-5, and Bob-1 and negative for Oct-2, CD3, CD20, surface immunoglobulin, CD56. On the basis of systemic evaluation and bone marrow examination, he was diagnosed with primary bone marrow Hodgkin lymphoma. We initiated therapy with DeVIC (dexamethasone, etoposide, ifosfamide, and carboplatin) therapy, but remission was not achieved. Then, the patient was treated with brentuximab vedotin combined with systemic chemotherapy (Adriamycin, vinblastine and dacarbazine), which was effective. Conclusions There is no established treatment strategy for Hodgkin lymphoma, and therapeutic outcomes using ABVD (Adriamycin, bleomycin, vinblastine and dacarbazine)-like or CHOP (cyclophosphamide, Adriamycin, vincristine, and prednisone)-like regimens are reportedly poor. Only a few patients have been reported to achieve long-term remission. Through this case report, we suggest an alternative therapeutic option for primary bone marrow Hodgkin lymphoma.
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Affiliation(s)
- Keiki Nagaharu
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan. .,Department of Hematology and Oncology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan.
| | - Masahiro Masuya
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Yuki Kageyama
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
| | - Takanori Yamaguchi
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| | - Ryugo Ito
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| | - Keiki Kawakami
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
| | - Masafumi Ito
- Department of Pathology, Japanese Red Cross Nagoya First Hospital, Aichi, Japan
| | - Naoyuki Katayama
- Department of Hematology and Oncology, Suzuka General Hospital, Mie, Japan
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Gallamini A, Hutchings M, Ramadan S. Clinical presentation and staging of Hodgkin lymphoma. Semin Hematol 2016; 53:148-54. [DOI: 10.1053/j.seminhematol.2016.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Fu R, Yu H, Wu YH, Liu H, Shao ZH. Hodgkin's lymphoma associated with myelofibrosis: A case report. Oncol Lett 2015; 10:1551-1554. [PMID: 26622707 DOI: 10.3892/ol.2015.3438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/20/2015] [Indexed: 01/20/2023] Open
Abstract
In the present study, the case of a patient with nodular sclerosing Hodgkin's lymphoma (NSHL) presenting with diffuse fibrosis of the bone marrow (BM) was reported. A 30-year-old male complained of fever for 1 year, as well as lumbago, lymph node swelling and night sweats for 3 months. A biopsy of the lymph nodes established a diagnosis of NSHL. Aspiration of BM was a dry tap, and the BM biopsy demonstrated marked myelofibrosis with increased proliferation of reticulin fiber. Multiple skeletal lesions were detected in the patient's vertebra, pelvis, sternum and bilateral femur by magnetic resonance imaging and computed tomography. Following numerous courses of chemotherapy and radiotherapy, remission of the lymphoma was achieved. Subsequently, the BM aspiration became possible, and BM biopsy demonstrated a reduction in fibrosis.
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Affiliation(s)
- Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Hong Yu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yu-Hong Wu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Hui Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zong-Hong Shao
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Weinzierl EP, Arber DA. The differential diagnosis and bone marrow evaluation of new-onset pancytopenia. Am J Clin Pathol 2013; 139:9-29. [PMID: 23270895 DOI: 10.1309/ajcp50aeeygrewuz] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
New-onset pancytopenia can be caused by a wide variety of etiologies, leading to a diagnostic dilemma. These etiologies range from congenital bone marrow failure to marrow space-occupying lesions, infection, and peripheral destruction, to name a few. Bone marrow examination, in addition to a detailed clinical history, is often required for an accurate diagnosis. The purpose of this review is to provide a brief overview of many of the causes of new-onset pancytopenia in adults and children, with emphasis on bone marrow findings and recommendations of additional testing and clinical evaluation when needed, with the overall aim of aiding the pathologist's role as a consultant to the patient's treating physician.
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Abstract
Numerous metabolic disorders, teratogenic agents, and in utero infections lead to congenital bone disease and malformation. This review focuses on hereditary and familial disorders of bone with particular emphasis on impaired hematopoiesis, myelofibrosis, pathologic fractures, and dysmorphology of the forearm and craniofacial structures. The severity of bone disease and marrow dysfunction of any given disorder may vary considerably from one affected individual to the next, and intrapersonal variability over time may be substantial as well. Both can impart difficulty to the appropriate evaluation and delay the correct diagnosis. Many of these disorders are phenotypically quite similar but require very different therapeutic intervention.
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Affiliation(s)
- Hans-Christoph Rossbach
- Division of Pediatric Hematology/Oncology, St. Joseph Children's Hospital, and University of South Florida, Tampa, Florida 33607, USA.
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Abstract
Essential thrombocythemia, polycythemia vera, and myelofibrosis with myeloid metaplasia constitute the "classic" bcr/abl-negative myeloproliferative disorders (MPDs). Each of these MPDs represents a stem cell-derived clonal myeloproliferation with the respective features of thrombocytosis, erythrocytosis, and bone marrow fibrosis. Unlike with cases of chronic myeloid leukemia, in which the bcr/abl mutation is invariably detected, current diagnosis of essential thrombocythemia, polycythemia vera, and myelofibrosis with myeloid metaplasia is based on a consensus-driven set of clinical and laboratory criteria that have undergone substantial modification in recent times. The recent discovery of a recurrent activating Janus tyrosine kinase (JAK2) mutation (JAK2VG17F) in all 3 classic MPDs offers another opportunity for refining current diagnoses and disease classifications. In this article, we outline contemporary diagnostic algorithms for each of these disorders and provide an evidence-based approach to management.
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Affiliation(s)
- Ayalew Tefferi
- Division of Hematology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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Affiliation(s)
- A Tefferi
- Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
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Mahoney DH, Schreuders LC, Gresik MV, McClain KL. Role of staging bone marrow examination in children with Hodgkin disease. MEDICAL AND PEDIATRIC ONCOLOGY 1998; 30:175-7. [PMID: 9434827 DOI: 10.1002/(sici)1096-911x(199803)30:3<175::aid-mpo9>3.0.co;2-e] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the value of bone marrow trephine biopsy as part of the clinical staging for children presenting with Hodgkin disease. PATIENTS AND METHODS A retrospective study of pre-treatment bone marrow examinations was undertaken to examine the value of bone marrow staging in children with Hodgkin disease. The records of 122 children, diagnosed with Hodgkin disease at Texas Children's Hospital between February 1960 and July 1996 were reviewed. Age, sex, complete blood counts (CBC), pathology, and clinical and pathological staging results were tabulated. RESULTS Information was complete for analysis in 110 patients. Bone marrow trephine biopsies identified Hodgkin disease in 2/110 patients (1.8%). The patients with bone marrow disease had clinical stage IIIB disease prebiopsy. Positive bone marrow biopsy results did not effect a change in therapy, and the small number of positive cases do not allow any prediction as to prognosis. CONCLUSION There is no role for bone marrow trephine examination in children with clinical stage I-IIIA Hodgkin disease.
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Affiliation(s)
- D H Mahoney
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 38-1997. Inflammation of the ears, anemia, and fever 21 years after treatment for Hodgkin's disease. N Engl J Med 1997; 337:1753-60. [PMID: 9411245 DOI: 10.1056/nejm199712113372408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Chubachi A, Wakui H, Miura I, Saitoh M, Nishinari T, Nishimura S, Miura AB. Extramedullary megakaryoblastic tumors following an indolent phase of myelofibrosis. Leuk Lymphoma 1995; 17:351-4. [PMID: 8580808 DOI: 10.3109/10428199509056844] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 59-year-old man developed multiple subcutaneous and bone tumors after 2 years' duration of indolent myelofibrosis. These tumors exhibited a diffuse proliferation of pleomorphic blast cells. The skeletal x-rays showed disseminated osteolysis and osteosclerosis. Blast cells obtained from the pleural effusion did not react with myeloperoxidase, sudan black B or non-specific esterase. Genotypic analysis of DNA samples at autopsy did not demonstrate rearrangements of T-cell receptor beta-chain or immunoglobulin heavy-chain genes. Frozen-section immunohistochemical studies revealed that the neoplastic cells were derived from megakaryocytic lineage. The present case represents a novel and unusual subtype of megakaryocytic neoplasm.
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Affiliation(s)
- A Chubachi
- Third Department of Internal Medicine, Akita University School of Medicine, Japan
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Hasselbalch HC. Idiopathic myelofibrosis--an update with particular reference to clinical aspects and prognosis. INTERNATIONAL JOURNAL OF CLINICAL & LABORATORY RESEARCH 1993; 23:124-38. [PMID: 8400333 DOI: 10.1007/bf02592297] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Idiopathic myelofibrosis (IMF) is characterized by excessive accumulation of connective tissue in the bone marrow as part of a clinical syndrome which in its classical form is featured by leukoerythroblastic anemia and huge splenomegaly at the time of diagnosis. An acute variant of the disease exists being featured by pancytopenia, nor or minimal splenomegaly and a rapidly fatal clinical course. This review describes the relationship of IMF to other chronic myeloproliferative disorders and highlights current concepts of the pathogenesis of bone marrow fibrosis, implicating the intramedullary release of various growth factors, including platelet-derived growth factor beta. In a subgroup of patients bone marrow fibrosis may develop consequent to autoimmune bone marrow damage. The clinical and laboratory findings in some of the larger series of patients are presented and the reasons for the highly variable clinical presentation and prognosis are critically discussed. It is proposed that studies on prognosis in IMF are based upon simple prognostic staging systems, which should include the Hb-concentration, platelet count, spleen size and the presence/absence of osteomyelosclerosis on X-ray. Using these parameters the patients are easily categorized into three prognostic groups with highly different survival times.
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Tak PP, Kluin PM, Hoogkamp-Korstanje JA, de Koning J, Bieger R, Kluin-Nelemans JC. A young man with fever, splenomegaly, hepatic granulomas, and lymphocytic bone marrow infiltrates. Ann Hematol 1993; 66:97-102. [PMID: 8166771 DOI: 10.1007/bf01695892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P P Tak
- Department of Hematology, University Hospital Leiden, The Netherlands
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Abstract
All cases of Hodgkin's disease (HD) notified to the Danish Cancer Registry from 1976 through 1987 in patients less than 70 years old were reviewed in order to identify patients in whom a correct diagnosis was established only post mortem. The case records of such patients were reviewed in a search for clinical features that could have ensured a correct pre mortem diagnosis. HD was diagnosed after death in 31 patients in this unselected population based study and thus constituting only 2.4% of all patients less than 70 years with HD, but 14.1% of the group aged 65-69 years. Most patients were identified during the first part of the study period, which may reflect a decreasing autopsy rate. HD was considered to be a coincidental finding in four patients and the primary cause of death in 27 patients. Among the later 27 patients a number of unfavourable prognostic factors were a common finding: persistent unexplained fever and weight loss, pancytopenia, hepatic involvement, bone marrow involvement, advanced stage disease, and lymphocytic depletion histology. However, most of the patients had no concurrent diseases and may have benefitted from a correct diagnosis and a potentially curative treatment. The many uncommon features of HD together with the frequent findings of falsely negative chest X-ray, bone marrow examination, liver biopsy, and ultrasound contributed to the difficulty in diagnosis. In about 1/3 of the patients clinical findings suggestive of lymphoma did not result in relevant diagnostic procedures.
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Affiliation(s)
- H Hasle
- Department of Oncology, Odense University Hospital, Denmark
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Johnston PG, Ruscetti FW, Connaghan DG, Sullivan FJ, Longo DL. Transient reversal of bone marrow aplasia associated with lymphocyte depleted Hodgkin's disease after combination chemotherapy. Am J Hematol 1991; 38:54-60. [PMID: 1897515 DOI: 10.1002/ajh.2830380109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This report describes a patient with lymphocyte depleted Hodgkin's disease who presented with bone marrow aplasia. The aplastic marrow reverted to normal after initiation of MOPP chemotherapy; however, 4 months after completion of therapy, bone marrow aplasia recurred in the absence of recurrent Hodgkin's disease. The patient remains free of Hodgkin's disease 34 months after completion of chemotherapy. Bone marrow abnormalities in Hodgkin's disease are reviewed and the current understanding of the pathological mechanisms leading to aplastic anemia is discussed.
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Affiliation(s)
- P G Johnston
- Medicine Branch, N.C.I., N.I.H., Bethesda, MD 20892
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Abstract
We report on the rare association of Hodgkin's disease with systemic lupus erythematosus. Two years after the diagnosis of systemic lupus erythematosus, the patient developed upper abdominal pain, jaundice, splenomegaly, and fever of unknown origin. He had a rapidly fatal clinical course, despite being treated for systemic lupus erythematosus, cholecystitis, and possible sepsis. Autopsy revealed Hodgkin's disease, lymphocyte-depletion type, involving lymph nodes, liver, spleen, and bone marrow. The awareness of the association of Hodgkin's disease with systemic lupus erythematosus and its modes of presentation will help in the early diagnosis and management of such patients.
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Affiliation(s)
- D Netto
- Laboratory Service, Veterans Affairs Medical Center, Dallas, TX 85012
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