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Print ISSN: 1792-1074 Online ISSN: 1792-1082
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February-2026 Volume 31 Issue 2

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Case Report Open Access

Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report

  • Authors:
    • Jing Yang
    • Sheng-Ke Tu
    • Hui Peng
    • Yuan-Yuan Peng
    • Min Li
    • Kui Song

  • View Affiliations / Copyright

    Affiliations: Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou, Hunan 416000, P.R. China, Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou, Hunan 416000, P.R. China
    Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 70
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    Published online on: December 5, 2025
       https://doi.org/10.3892/ol.2025.15423
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Abstract

Primary bone marrow (BM) diffuse large B‑cell lymphoma (PBM‑DLBCL) is an extremely rare and highly aggressive subtype of extranodal lymphoma. Its non‑specific clinical manifestation, often presenting with pancytopenia, poses significant diagnostic challenges, frequently leading to misdiagnosis as other hematological disorders. In April 2023, a 70‑year‑old man was hospitalized in the Department of Hematology of The First Affiliated Hospital of Jishou University (Jishou, China). The patient presented to the hospital with fever, malaise and severe pancytopenia. An initial BM biopsy indicated a T‑cell lymphoproliferative disorder accompanied by myelofibrosis (MF), for which empirical immunosuppressive therapy was administered without clinical benefit. A total of 10 months later, a repeat BM biopsy demonstrated a distinct population of CD20+ and CD79a+ large B‑cells, establishing a definitive diagnosis of PBM‑DLBCL with secondary MF. The patient declined further therapeutic interventions and was lost to follow‑up thereafter. The present case report underscores the diagnostic challenges of PBM‑DLBCL, which can mimic other marrow pathologies. The report highlights the critical importance of repeat BM biopsies in cases of refractory or unexplained pancytopenia. The potential mechanisms linking DLBCL with secondary MF are also discussed, emphasizing the need for heightened clinical vigilance to prevent misdiagnosis.
View Figures

Figure 1

Flow cytometric analysis of surface marker expression. Representative flow cytometry plots gated on relevant lymphocyte populations. The analysis shows the expression profiles and co-expression of various B-cell markers, including CD19, CD20 and CD3, among others, as indicated on the axes. Percentages within the quadrants indicate the proportion of cells positive for the respective markers. Samples were acquired from peripheral blood. The specific sample identifier is Le0754 1925-079245-02, with an acquisition date of 2023-04-06.

Figure 2

Initial bone marrow biopsy (April 2023). Morphological analysis of hematoxylin and eosin-stained sections revealed myeloproliferative changes with dense infiltration of small-to medium-sized lymphocytes (red-marked areas). Combined reticulin staining demonstrated prominent stromal fibrosis in the bone marrow (yellow-marked areas), confirming the presence of densely branched reticular fibers consistent with Grade 2 myelofibrosis (OLYMPUS BX43 microscope). (A) ×40 magnification and (B) ×400 magnification.

Figure 3

Second bone marrow biopsy (March 2024). Microscopic analysis of hematoxylin and eosin-stained sections revealed prominent lymphocytic hyperplasia with moderately enlarged cells (red-marked areas). Reticulin staining identified focal collagen fiber proliferation within the bone marrow stroma (yellow-marked areas), confirming the presence of densely branched reticular fibers consistent with Grade 2 myelofibrosis (OLYMPUS BX43 microscope). (A) ×40 magnification and (B) ×400 magnification.
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Copy and paste a formatted citation
Spandidos Publications style
Yang J, Tu S, Peng H, Peng Y, Li M and Song K: Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report. Oncol Lett 31: 70, 2026.
APA
Yang, J., Tu, S., Peng, H., Peng, Y., Li, M., & Song, K. (2026). Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report. Oncology Letters, 31, 70. https://doi.org/10.3892/ol.2025.15423
MLA
Yang, J., Tu, S., Peng, H., Peng, Y., Li, M., Song, K."Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report". Oncology Letters 31.2 (2026): 70.
Chicago
Yang, J., Tu, S., Peng, H., Peng, Y., Li, M., Song, K."Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report". Oncology Letters 31, no. 2 (2026): 70. https://doi.org/10.3892/ol.2025.15423
Copy and paste a formatted citation
x
Spandidos Publications style
Yang J, Tu S, Peng H, Peng Y, Li M and Song K: Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report. Oncol Lett 31: 70, 2026.
APA
Yang, J., Tu, S., Peng, H., Peng, Y., Li, M., & Song, K. (2026). Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report. Oncology Letters, 31, 70. https://doi.org/10.3892/ol.2025.15423
MLA
Yang, J., Tu, S., Peng, H., Peng, Y., Li, M., Song, K."Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report". Oncology Letters 31.2 (2026): 70.
Chicago
Yang, J., Tu, S., Peng, H., Peng, Y., Li, M., Song, K."Primary bone marrow diffuse large B‑cell lymphoma with secondary myelofibrosis: A case report". Oncology Letters 31, no. 2 (2026): 70. https://doi.org/10.3892/ol.2025.15423
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