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case_images: CT scan of the abdomen demonstrates hepatomegaly and splenomegaly
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case_images: He was noted to have pancytopenia and hepatomegaly, and splenomegaly (21 cm) on CT scan (Figure 1).
case_images: Bone marrow aspirate. High power view. Hypercellular for age (80%). Demonstrates involvement with T-cell lymphoma and hemophagocytes
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case_images: T-cell lymphoma, compromising about 5% of the cellularity as well as a moderate number of hemophagocytes (Figure 2). There is bone marrow involvement in most patients at diagnosis7, 11 and hemophatocytosis is a recognized but infrequent phenomenon that can develop in patients with HSTCL.7 The aspirate demonstrated a hypercellular marrow and normal erythroid number and maturation.
case_images: Bone marrow biopsy. Low power view. CD3 immunohistochemical staining consistent with lymphoma cells. Immunophenotyping was positive for CD16, and CD57 and was double negative for CD4 and 8
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case_images: CD20 was negative in neoplastic cells and positive in sparse background small B-cells. CD3 was positive in neoplastic cells (Figure 3), many within marrow sinusoids, with intermediate nuclei, open chromatin, and a variably prominent nucleolus, overall comprising about 5% of the cellularity.
case_images: Bone marrow biopsy. The IHC stain was also positive for KP1 (CD68), highlighting the nuclei of engulfed cells within macrophages
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case_images: IHC stain was also positive for KP1 (CD68), highlighting the nuclei of engulfed cells within macrophages (Figure 4). Immunophenotyping by flow cytometry demonstrated the following phenotype:
case_images: Liver biopsy. High power view. Sinusoidal infiltration of hepatic sinusoids by lymphocytes
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case_images: IL-2, and hemophagocytes bought the diagnosis of HLH. In light of the hepatomegaly, a liver biopsy was pursued which confirmed a diagnosis of HSTCL involvement in the liver (Figure 5). The lymphoma cells infiltrated the liver sinusoids (Figure 5), which is a typical finding with HSGDTL.1, 7 IHC stains were positive for CD3 and CD56.