Diagnosing a hematopoietic malignancy during shoulder arthroplasty: A case report

Abstract

Introduction. Determining the cause of shoulder pain is usually a challenge as many problems, such as rheumatoid arthritis, osteoarthritis, osteonecrosis, rotator cuff arthropathy, traumatic arthritis, fractures, conditions of cervical vertebra, and neo-plasms, can produce similar symptoms. The diagnosis is usually regarded as incidental, however, chronic lymphocytic leukemia (CLL) diagnosis by the histopathological evaluation performed on lymph nodes excised during a shoulder procedure has not been reported in the literature, to the best of our knowledge. We present a CLL-small lymphocytic lymphoma (SLL) case diagnosed incidentally during reverse shoulder arthroplasty. Case report. A 69-year-old female with a history of left proximal humerus fracture a year prior was presented to our outpatient clinic with left shoulder pain. A proximal humerus non-union was revealed radiographically. The patient underwent reverse shoulder arthroplasty. During surgery, a 2.5 ? 1.5 ? 1 cm sized lymph node was observed near the left cephalic vein. The lymph node biopsy result was reported to be CLL-SLL. The patient had no early postoperative complications and was dis-charged two days after. At her final evaluation, she was free of orthopedic complaints and was consulted with the hematology department to receive CLL-SLL treatment. Conclusion. Elderly patients presenting with non-union should be questioned for vague symptoms; lymph nodes surrounding the non-union site should be examined thoroughly. Any suspicious lymphadenopathy encountered during orthopedic surgery should be excised and sent for pathological evaluation