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bloodwork
IMAGES
IN
HEMATOLOGY
Gelatinous transformation
A
B
C
● Claudiu V. Cotta, Cleveland Clinic
69-year-old man developed fatigue, dyspnea, expanding girth, night sweats, and weight loss. On
A 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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2166
BLOOD, 13 SEPTEMBER 2012 䡠 VOLUME 120, NUMBER 11
From www.bloodjournal.org by guest on June 18, 2017. For personal use only.
2012 120: 2166
doi:10.1182/blood-2012-02-408815
Gelatinous transformation
Claudiu V. Cotta
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