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Gelatinous transformation

Gelatinous transformation
#00013809
Author: Claudiu V. Cotta
Category: Laboratory Hematology > Non-hematopoietic malignancies involving the blood or bone marrow
Published Date: 12/09/2012

A man developed fatigue, expanding girth, and weight loss.He had ascites. He had normocytic anemia (hemoglobin 8.2 g/dL), and a normal peripheral smear. Lactate dehydrogenase was 7500 u/L and marked hypogammaglobulinemia (0.24 g/dL). The ascitic fluid showed lymphoma cells. CT showed pleural effusions, ascites, and abdominal and mediastinal masses. 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 gelatinous transformation characterized by extracellular deposits of amorphous, 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.