Lung Cancer with an Increase in Macrophage Displaying Marked Hemophagocytosis in the Bone Marrow

Abstract

Occurrance of clinical and histological picture mimicking histiocytic meddulary reticulosis has been reported in association with some viral infections, miliary tuberculosis, typhoid fever and gastric cancer. Reported herein is a patient with lung cancer presenting with such a picture: A 75 year-old male was admitted on 1/25/'83 with productive cough, hemoptysis, anorexia and weight loss. A diagnosis of squamous cell carcinoma of the lung with metastasis to the right supraclavicular nodes and liver was made in the hospital. RBC and platelet counts were initially normal and WBC count was 22,700/μl with neutrophilia. However, following an episode of transient fever, RBC, WBC and platelet counts progressively decreased to 227×10⁴/μl, 14,600/μl and 3.8×10⁴/μl respectively within 3 weeks without use of any anti-mitotic agents. The patient died of general emaciation. Bone marrow aspiration performed shortly before death revealed normoplastic marrow without invasion of tumor cells. Characteristically, However, an increase in macrophage, displaying marked hemophagocytosis forming clumps in some areas was noted. Autopsy revealed no distinct histiocytosis in the bone marrow, liver, or spleen. We consider that this represents a case with reactive reticulosis possibly induced by tumor-associated antigen or the antigen-antibody complex.