In summary you have a gentleman in his 60s with previous splenectomy and high grade diffuse large B cell lymphoma treated with CHOP chemotherapy. He has presented with B symptoms and pancytopenia. He has some interesting travel history. From a haematology point of view you’re worried about secondary acute myeloid leukaemia/myelodysplastic syndrome or relapsed disease. He has hepatomegaly but it is thought a marrow biopsy is less risky than liver biopsy due to coagulopathy.

Here  is the marrow

Questions

• Has your differential changed?
• How would you describe the appearances?

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