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  #1  
Old 10-01-2011
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Microscope Bone Marrow Histology Question!

An 8-year-old Afghan girl presented with a two-month history of edema, abdominal distension, weakness, pallor, chills, fever, anorexia, and weight loss. Her medical history was not remarkable. Physical examinations showed severe mucosal and conjunctival pallor, periorbital and sacral edemas, and abdominal distension. She also presented with tender mobile lymph nodes in her right neck (5 5 mm), bilateral inguinal area (0.5 cm 0.5 cm) and left axillary (0.7 cm 0.7 cm), as well as marked hepatosplenomegaly and ascites with shifting dullness. Systolic murmurs (II/III) of the heart and lungs were apparent. Laboratory findings included severe anemia with moderate anisopoikilocytosis, hemoglobin level of 3.2 (normal range 260 to 400 mg/dl), erythrocyte sedimentation rate of 50 (normal range <15 mm/hr), and positive C-reactive protein. Polymerase chain reaction for tuberculosis, blood culture, urine culture, hydatid antibody, Coombs Wright and 2 ME, direct Coombs, bone marrow culture, and blood smears for malaria and borrelia were all negative. Patient's G6PD level was also normal. Bone marrow histology is shown below:

Bone Marrow Histology Question!-bone-marrow-histology.jpg
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What is the most likely diagnosis?

A) AML
B) CML
C) Multilpe myeloma
D) Idiopathic cardiomyopathy
E) Hodgkin lymphoma
F) ALL
G) Waldenstrom hypogammaglobulinemia
H) Syphilis
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Old 10-01-2011
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E) Hodgkin lymphoma
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Old 10-01-2011
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c, Multiple Myeloma
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Old 10-02-2011
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I m with E
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Old 10-02-2011
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E) Hodgkin lymphoma

the presence of RS cell in histology
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Old 11-20-2011
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Look like Hodgkin lymphoma, but ALL is still of a high probability, RS cells aren't that clear though.
IF you have the answer please submit it.
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Old 11-20-2011
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by the way, RS cells usually found in lymph node's biopsy.
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Old 11-20-2011
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a, hodgkin's there is non tender lymadenopathy
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Old 11-20-2011
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hodgkins lyphoma...i guess coz of the histo pic
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Old 11-20-2011
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ok, after some research I did, I found that same picture in this question is from a lymph node ,not a bone marrow, and that's why you see those mixed cells.
It's for sure mix cellularity hodgkin's lymphoma.
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