ACTA FAC MED NAISS 2014;31(4):261-265

Case report

UDC: 616.15-006

DOI: 10.2478/afmnai-2014-0032

Extensive Bone Marrow Involvement in Hodgkin Lymphoma Patient

Ivan Petković¹, Miljan Krstić^2,3, Slavica Stojnev³, Ivica Pejčić^1,3, Svetislav Vrbić^1,3

¹Oncology Clinic, Department for Hematooncology, Clinical Centre Niš, Serbia

²Center for Pathology, Clinical Centre Niš, Serbia

³University of Niš, Faculty of Medicine, Serbia


SUMMARY

Bone marrow involvement is rare in patients with Hodgkin lymphoma (HL). Its incidence varies with respect to risk factors from 4% to 14%. Low risk patients do not need trephine biopsy according to some research. In the era of positron emission tomography/computed tomography (PET/CT) staging prior to therapy, the role of trephine biopsy as a part of staging procedures becomes debatable. Many institutions worldwide created their own guidelines in the application of trephine biopsy in staging of the (HL) patients. Our institution prefers performing trephine biopsy in all risk group patients, except those who underwent PET/CT staging before therapy and if no active bone sites were found. Most of our patients are staged using multislice computed tomography (MSCT) and we perform PET/CT in the follow up after completing the induction protocol. That is why we propose the trephine biopsy to the most of our patients. A Greek group of authors have derived a clinical prediction rule for the possibility of the bone marrow involvement, which is named the Z score (Zs), and if it is ≥10, patients are at high risk for bone marrow involvement. We present a case of a neglected, advanced (HL) patient, with the defined high risk for bone marrow involvement (Zs=25). He was clinically suspected to have affected bone marrow, which was later histologically confirmed. Unilateral trephine biopsy was performed.

Key words: Hodgkin lymphoma, bone marrow involvement, HRS cells, trephine biopsy