Case 27

A 59-year-old man presented with a low grade fever for two weeks with abdominal pain, increasing fatigue, and drenching night sweats. Physical examination revealed no lymphadenopathy or hepatosplenomegaly. However, a computed tomography scan showed marked splenomegaly and diffuse abdominal adenopathy. Laboratory testing demonstrated pancytopenia and a highly elevated lactate dehydrogenase (1076 IU/l). Due to his critical condition, lymph node biopsy was not attempted and a bone marrow biopsy was performed instead. The biopsy showed multiple intertrabecular lymphoid aggregates, suspicious of lymphoma (Fig. 27.1). Subsequently, a right groin lymph node was biopsied (Fig. 27.2).