Primary non-Hodgkin Lymphoma Of Bone Research Articles

Sclerotic changes on plain X-ray led to early diagnosis and successful treatment of primary lymphoma of iliac bone.

Sir, A previously healthy 54-year-old woman presented to our hospital with a 3-month history of pelvic pain. There was no history of constitutional symptoms such as unintentional weight loss, fever, and loss of appetite. Clinical examination revealed pain on deep palpation of the right iliac region. There was no evidence of soft tissue swelling or redness in the site of patient's pain. The rest of physical exam was unremarkable. Laboratory investigations were within normal limits (erythrocytes sedimentation rate of 20 mm in the 1st h, negative C-reactive protein and white blood count of 4800 per μl). A plain radiograph of the pelvis showed slightly lytic-sclerotic changes of right iliac bone with indistinct margins, which at a shallow observation confused with bowel gases [Figure 1]. A computed tomography (CT) was performed and showed a slightly expansile lytic-sclerotic lesion with small soft tissue component in the right iliac bone [Figure 2]. The bone scan also revealed isolated uptake of technetium-99m in the right ilium [Figure 3]. According to the patient age, the differential diagnosis included metastasis, lymphoma, plasmacytoma, and chronic osteomyelitis. Figure 1 Radiograph of pelvis demonstrates lytic-sclerotic changes of right iliac bone Figure 2 Pelvic computed tomography image shows a slightly expansile lytic-sclerotic lesion in the right iliac bone with no extension to the sacroiliac joint Figure 3 Bone scan revealed isolated uptake of technetium-99 m in the right ilium The core needle biopsy result was consistent with the diagnosis of diffuse large B-cell nonHodgkin's lymphoma. There was not any other site of involvement on CT scan of the chest, abdomen, and pelvis. Positron emission tomography (PET) also showed no secondary absorption of fluorodeoxyglucose [Figure 4]. The diagnosis of primary nonHodgkin lymphoma of bone was made, and the patient was successfully treated with a combination of chemotherapy and radiotherapy. Figure 4 Positron emission tomography scan showed no secondary absorption of fluorodeoxyglucose NonHodgkin's lymphoma of bone is a rare entity which is limited to the long bones and axial skeleton, with the femur being the most common site of involvement. Primary involvement of iliac bone is extremely rare. There are no clinical or radiological characteristics which be diagnostic for primary bone lymphoma. The image findings in radiograph or CT scan are variable and nonspecific, range from near normal to diffuse permeative pattern.[1,2,3,4,5,6] A review article performed by Mulligan et al., revealed that the most common features on imaging studies are lytic (70%), including permeative or moth-eaten pattern, and mixed lytic and sclerotic density (28%). Periosteal reaction and soft tissue mass were reported in 58%, and 80-100% of cases, respectively, in this study.[2] Sequestrum formation considered as a radiological feature which may help to differentiate between plasmablastic lymphoma (PBL) and other conditions such as metastasis and myeloma. Sequestrum formation has been reported in 11-16% of PBL cases.[7] Cross-sectional imaging studies are useful adjuncts to conventional radiography. Extensive involvement of bone marrow cavity with a surrounding soft tissue component and without extensive cortical destruction is a pattern, which is reported only in PBL, Ewing sarcoma, and myeloma.[8] The key educational message of our case is that any change on plain X-ray is valuable and should not be overlooked. This case also reminds us the importance of considering primary nonHodgkin lymphoma as a valuable differential diagnosis in lytic and sclerotic lesions of iliac bone. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Primary non-Hodgkin lymphoma of bone: An unusual presentation

Primary lymphoma of bone (PLB) is an extremely rare condition that is usually confused with other primary injuries of the bone. It is characterized by the involvement of one or more bone locations, with or without involvement of regional lymph nodes and viscera. PLB constitutes 3-7% of all malignant bone tumors and approximately 3% of all extranodal lymphomas. It is found at all ages, being most frequently seen in adult life. Any part of the skeleton can be involved, but a trend exists in favor of bones with persistent bone marrow. We report a case of PLB with an unusual presentation: involvement of the proximal phalanx of the thumb. Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide established complete remission. Consolidation with radiotherapy of the femur and phalanx was performed. There was no evidence of recurrence at the 14 th month follow-up.

Primary non-Hodgkin lymphoma of bone in children:a report of 3 cases

儿童原发于骨的非霍奇金氏淋巴瘤(non-Hodgkin lymphoma,NHL)极为少见,临床上很难与其他儿童骨的恶性肿瘤鉴别.现报告3例经病理证实的儿童骨原发性NHL,并分析其影像特征。

Clinicopathologic features, prognosis and etiology of primary non-Hodgkin lymphoma of bone

To study the clinicopathologic features, prognostic indicators and possible etiology of primary non-Hodgkin lymphoma of bone (PNHLB). The clinicopathologic features of 17 cases of PNHLB were reviewed. In-situ hybridization for Epstein-Barr virus early RNA (EBER) and polymerase chain reaction for bcl-2/JH gene rearrangement were performed using paraffin-embedded materials. The correlation between serum lactic dehydrogenase level, treatment options, international prognostic indicator (IPI) and immunophenotype with clinical outcome were analyzed. The majority of the 17 cases studied was diffuse large B-cell lymphoma (94.1%). The 5-year survival rate was 68.8%. Unfavorable prognostic factors included high-risk IPI (P = 0.031) and bcl-2 overexpression (P = 0.028). Treatment options and expression of CD10, MUM-1 or bcl-6 did not correlate with clinical outcome (P > 0.05). Only 1 patient was positive for EBER, as demonstrated by in-situ hybridization. The clinical outcome of PNHLB is relatively favorable. IPI and bcl-2 expression may serve as useful prognostic indicators. EBV is likely not related to pathogenesis of this type of lymphoma.

Primary lymphoma of bone in children: analysis of treatment results with adriamycin, prednisone, Oncovin (APO), and local radiation therapy.

Primary lymphoma of bone is an unusual extranodal presentation of pediatric non-Hodgkin's lymphoma (NHL). Treatment with radiotherapy alone has resulted in a disease-free survival rate of approximately 50% in most adult series. Between January 1973 and April 1985, 11 children with biopsy-proven NHL of bone were seen and treated at our institutions. The minimal clinical staging included chest and bone radiographs, a radionuclide bone scan, complete blood cell counts and serum chemistries, and a bone marrow aspirate and biopsy. The age range was 9 to 17 years with a median age of 14 years. Histology included diffuse lymphoblastic lymphoma in four patients and diffuse histiocytic lymphoma in seven. Each patient was treated with the Adriamycin/prednisone/Oncovin (APO) protocol and ten patients received concomitant radiation to the whole bone when possible and a boost to the primary lesion(s). The median tumor dose was 5,000 rad (range, 3,600 to 5,600). The median follow-up was 8 years. There have been no relapses, but two patients have developed second bone tumors 5 and 7 1/2 years after beginning therapy. Each second tumor arose directly in the radiation field. The overall 8-year actuarial survival is 83%. We conclude that APO and local radiation results in excellent overall survival for children with primary NHL of bone. The occurrence of two second bone tumors, however, raises questions regarding dose and/or the role of radiation for this disease.