Abstract
Primary lymphoma of the bone (PLB) primarily arising from the medullary cavity is an extremely rare entity, with only retrospective studies and sporadic cases reported in the literature. The current study presents one case of PLB treated with chemotherapy and radiotherapy, and a review of the literature to elucidate the optimal treatment of PLB. A 73-year-old female presented with pain in the left hip that had persisted for two months. Plain X-ray and magnetic resonance imaging of the left hip showed lytic areas involving the left innominatum. Technetium-99m radionuclide imaging showed increased tracer uptake in the ilium, acetabulum and ischium. An 18F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) scan showed high FDG uptake. A fine-needle aspiration biopsy of the lesion was performed, and histopathological and immunohistochemical examination confirmed a diagnosis of B-cell lymphoma. The patient received radiation therapy followed by six cycles of CHOP regimen (1,000 mg cyclophosphamide, 80 mg epirubicine and 2 mg vincristine on day one, and 100 mg prednisone on days one to five, every three weeks) and achieved a complete response, as confirmed by FDG-PET-CT. At present, the patient is in a good condition. This case is noteworthy, as it is a well-documented case in which the patient received successful treatment. This case demonstrates that PLB has an improved prognosis compared with primary lymphoma of other sites; however, combined therapy may further improve the patient outcome.
Highlights
Primary lymphoma of the bone (PLB) is an extranodal lymphoma that arises from the medullary cavity and manifests as a localized, solitary lesion, which represents ~3% of all primary malignant bone tumors and 1% of all malignant lymphomas [1]
The present study reports one case of PLB of the bone and a review of the literature with regard to PLB to elucidate the clinical manifestation, imaging features, staging, diagnosis and differential diagnosis, optimal treatment and prognosis of this unique disease
Immunohistochemistry showed that the cell membrane was strongly positive for cluster of differentiation (CD)20 and negative for CD79α, CD3, CD78, CD138, cytokeratin (CK) and CK8/18, supporting a B‐cell origin (Fig. 4)
Summary
Primary lymphoma of the bone (PLB) is an extranodal lymphoma that arises from the medullary cavity and manifests as a localized, solitary lesion, which represents ~3% of all primary malignant bone tumors and 1% of all malignant lymphomas [1]. The cell subtype of PLB varies and the molecular features have not been well studied [4]. As PLB is a highly curable disease, it is important for it to be differentiated from other causes of lytic bone lesions, such as carcinomas and other primary bone tumors. The present study reports one case of PLB of the bone and a review of the literature with regard to PLB to elucidate the clinical manifestation, imaging features, staging, diagnosis and differential diagnosis, optimal treatment and prognosis of this unique disease. Plain X‐rays showed no abnormalities of the pelvic bones, magnetic resonance imaging (MRI) of the left hip was performed and showed abnormal signals involving the left innominatum, with soft tissue formation. The patient is being regularly followed up and has remained disease‐free since the last treatment, with the exception of the broken femoral neck
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