Primary multifocal extranodal lymphoma in left humerus, two kidneys and ileum: one case report and literature review

Abstract

In this paper, we analyzed one case of primary multifocal extranodal non-Hodgkin’s lymphoma and reviewed the related literatures.We investigated the clinical data of this case with primary multifocal extranodal lymphoma and retrospected the related references.The key words, primary extranodal lymphoma and multifocal, were used to search Pubmed and Wanfang Database, and finally only three cases were found.The 68-year-old woman was confirmatively diagnosed as primary multifocal extranodal B cell non-Hodgkin’s lymphoma.The positron emission tomography/computed tomography (PET/CT) scan showed multiple hypermetabolic lesions in the left humerus, both kidneys and ileum.The confirmative diagnosis was based on clinical manifestations and serological tests, imaging features of CT and PET/CT, and especially on the histopathological and immunohistochemical studies.After one cycle chemotherapy (rituximab, Vincristine and prednisone) and another cycle (rituximab, Vincristine, cyclophosphamide and prednisone), a repeat PET/CT scan showed a complete metabolic resolution of the lesions in the kidneys and ileum, and a partial metabolic resolution of the left humerus.After four cycles of chemotherapy, there were new extensive involvements of the right supraclavicular and intrapulmonary lymph nodes, bilateral pleural and pericardium, and the patient gave up chemotherapy.This case demonstrated the imaging findings of an uncommon primary multifocal extranodal lymphoma in left humerus, both kidneys and ileum, and highlighted the usefulness of CT and PET/CT scan in identifying the extent of disease involvement, in guiding a biopsy, and in assessing the treatment response of lymphoma.It is essential to differentiate between primary multifocal extranodal lymphoma and lymphoma extensive metastases. Key words: Lymphoma; Bone; Kidney; Ileum