PMC4880433_01
Photomicrography of the peripheral blood smear A, B - and bone marrow aspiration smear; C, D - (Leishman stain), showing large cells with abundant basophilic cytoplasm, and nuclei with loose chromatin and evident nucleolus.
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The peripheral blood count, before the blood transfusion, showed hemoglobin of 3.9 g/dL (reference value [RV]: 13.5-17.5 g/dL), hematocrit of 12.5% (RV: 41-53%), and leukocytes count of 31,470/mm3 (RV: 4,500-11,000/ mm3) with 19% of medium-sized cells characterized by basophilic cytoplasm, medium nucleus/cytoplasm relationship, loose chromatin, evident nucleolus (Figure 1A, B), and platelets of 52,000/mm3 (RV: 150,000-400,000/mm3). Bone marrow aspiration showed erythroid hyperplasia and 23.6% of lymphocytes with varied morphology-2.8% of which were represented by large-sized cells with medium nucleus/cytoplasm relationship, basophilic cytoplasm, and loose chromatin (Figure 1C, D).
Abdominal CT showing lymphadenomegaly. A - Perigastric; B - Periportal space; C - Mesenteric region; D - Hepatosplenomegaly with perfusional heterogeneity in the spleen consistent with infarction.
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The spleen was enlarged and exhibited heterogeneous attenuation coefficient (Figure 2).
Photomicrography of the bone marrow. A - Massive marrow infiltration by lymphoma cells (H&E, 100X); B - Lymphoma cells, composed of large atypical cells with blue cytoplasm; round, irregular and vesicular nuclei with prominent nucleoli; and abundant cytoplasm. Some cells present homogeneous eosinophilic cytoplasm (H&E, 400X); C - Positivity for CD 20 in the lymphomatous cells (200X); D - Positivity for BCL-2 in the lymphomatous cells (400X).
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A bone marrow biopsy showed massive lymphomatous cells infiltration (60-65%), composed by large cells-some of them with homogeneous eosinophilic cytoplasm (Figure 3).