A 69-year-old man developed fatigue, dyspnea, expanding girth, night sweats, and weight loss. On examination he had ascites and peripheral edema. He had normocytic anemia (hemoglobin 8.2 g/dL), normal white count, minimal lymphopenia, normal platelet count, and a normal peripheral smear. Lactate dehydrogenase was 7500 u/L and serum proteins noted with mild hypoalbuminemia and marked hypogammaglobulinemia (0.24 g/dL). The ascitic fluid showed lymphoma cells. Computed tomography showed pleural effusions, ascites, and abdominal and mediastinal masses. An abdominal lymph node biopsy made the diagnosis of B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. The bone marrow aspirate revealed trilineage hematopoiesis and poorly stained acellular material. The bone marrow biopsy showed extensive gelatinous transformation characterized by extracellular deposits of amorphous, smooth, gelatinous material (panel A; HE), rich in hyaluronic acid that was Alcian Blue stain positive (panel B). After treatment with hyaluronidase (panel C; Alcian Blue with Hyaluronidase) the stain became negative. Combination chemotherapy resulted in clinical remission. No posttherapy bone marrow biopsy has been performed.
Gelatinous transformation or serous fat atrophy has been described in cancer-related cachexia and end-stage renal disease. It has since been noted with myxedema, anorexia nervosa, infections, and malignant neoplasms, including lymphoma. Currently it is mostly noted in anorexia nervosa, predominantly in marathon runners, and in end-stage AIDS. Gelatinous transformation of the bone marrow is uncommon but it can be identified by radiologists on magnetic resonance imaging (MRI). There were no MRIs performed on this patient.
A 69-year-old man developed fatigue, dyspnea, expanding girth, night sweats, and weight loss. On examination he had ascites and peripheral edema. He had normocytic anemia (hemoglobin 8.2 g/dL), normal white count, minimal lymphopenia, normal platelet count, and a normal peripheral smear. Lactate dehydrogenase was 7500 u/L and serum proteins noted with mild hypoalbuminemia and marked hypogammaglobulinemia (0.24 g/dL). The ascitic fluid showed lymphoma cells. Computed tomography showed pleural effusions, ascites, and abdominal and mediastinal masses. An abdominal lymph node biopsy made the diagnosis of B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. The bone marrow aspirate revealed trilineage hematopoiesis and poorly stained acellular material. The bone marrow biopsy showed extensive gelatinous transformation characterized by extracellular deposits of amorphous, smooth, gelatinous material (panel A; HE), rich in hyaluronic acid that was Alcian Blue stain positive (panel B). After treatment with hyaluronidase (panel C; Alcian Blue with Hyaluronidase) the stain became negative. Combination chemotherapy resulted in clinical remission. No posttherapy bone marrow biopsy has been performed.
Gelatinous transformation or serous fat atrophy has been described in cancer-related cachexia and end-stage renal disease. It has since been noted with myxedema, anorexia nervosa, infections, and malignant neoplasms, including lymphoma. Currently it is mostly noted in anorexia nervosa, predominantly in marathon runners, and in end-stage AIDS. Gelatinous transformation of the bone marrow is uncommon but it can be identified by radiologists on magnetic resonance imaging (MRI). There were no MRIs performed on this patient.
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