PMC5122011_01
Marrow aspirate smear showing examples of hemophagocytosis, May Grunwald Giemsa stain, x 1000
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Fig1
Hemophagocytic lymphohistiocytosis was strongly suspected according to Henter criteria and a bone marrow aspiration was performed showing a rich marrow with hemophagocytosis (Fig. 1) without lymphomatous infiltration.
Lymphadenopathy biopsy showing diffuse lymphohystiocytic infiltration the normal architecture with scattered large atypical cells (Arrows), H&E stain, x 400
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Fig2
These scattered large neoplastic cells are present on a background rich in histiocytes and small lymphocytes (Fig. 2).
CD20 immunostain highlights large neoplastic B cells, x 400
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Fig3
CD20 in the large neoplastic cells (Fig. 3) and CD3 in the small T cells (Fig. 4). CD30, CD15 and EBV stains were negative.   
CT scan abdomen showing a 20 cm large spleen with multiple hypodensities (infarcts)
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Fig5
Computed tomography (CT) scan of the chest, abdomen and pelvis showed enlarged lymph nodes on both sides of diaphragm and a 20 cm large spleen with multiple hypodensities, likely to be related to infarcts (Fig. 5).