Skeletal Muscle Lymphoma Research Articles

A case of primary skeletal muscle lymphoma mimicking cellulitis

Primary skeletal muscle lymphoma is a rare entity. Their presentation can be easily confused with a wide variety of inflammatory conditions, neoplasia as well as infectious diseases. We came across a 65-year-old lady who presented to us with complains of pain and swelling in the right thigh, leg and foot and fever-on and off for 20 days. She was initially managed elsewhere on the line of cellulitis with incision and drainage of right leg 15 days back but there had been no clinical improvement. We took her detailed history and examined her thoroughly. Relevant blood investigations were sent. However, the clinical examination findings and history were suggestive of an infective cause, blood investigations were suggestive of an acute inflammatory pathology, whereas radiological investigations (NCCT and X-ray) and cytological investigations (FNAC) which were performed at the previous place of treatment were inconclusive. We then did a CE-MRI of the right lower limb which showed centrally necrotic, enhancing mass lesion involving peroneal muscles with multiple enlarged inguinal and popliteal lymph nodes. Based on this finding, biopsy was performed and specimen was sent for histopathological examination which revealed “malignant small round cell tumor”. Immunohistochemistry was then done and tumor cells were found to be positive for vimentin, LCA, CD20 and negative for PANCK and CD3. Based on the above findings it was diagnosed as “non-hodgkin’s lymphoma (NHL) B-cell type” of right leg. Considering the confusing clinical presentation of this entity and inconclusiveness of blood and basic radiological investigations, lesions of extremities presenting with features of cellulitis must be carefully assessed.

A case of primary soft-tissue lymphoma of the lower extremity complicated with bacterial infection in a patient with acquired immunodeficiency syndrome

A patient with primary skeletal muscle lymphoma underwent plain and contrast-enhanced computed tomography (CT) and a pathologic diagnosis was made. The affected muscles were diffusely swollen, with recognizable outlines and clear borders. Contrast-enhanced CT showed mild-to-moderate enhancement, and the spaces surrounding the muscle and subcutaneous fat were narrowed and blurred. Primary skeletal muscle lymphoma is relatively rare and not very specific in its imaging manifestations. The final diagnosis depends on a biopsy of the lesion and immunohistochemistry.

Primary Anaplastic Large Cell Lymphoma of Skeletal Muscle Around the Left Hip Joint

Primary Anaplastic Large Cell Lymphoma of Skeletal Muscle Around the Left Hip Joint

A CASE OF MULTI REGIONAL PRIMARY MUSCLE LYMPHOMA

Primary extranodal non-Hodgkin's lymphoma (eNHL) usually presents at an early stage, as an extranodal organ involvement along with draining lymph nodes only or the predominant site is extranodal. As an eNHL, primary skeletal muscle lymphoma is very rare. The usual clinical picture is local swelling and pain with or without systemic symptoms. MRI features are distinctive and FDG-PET/CT may help to evaluate the stage and monitor the response to the treatment. A 56-year-old male, presented with a one-month history of swelling and pain on his left ankle. There was no history of trauma or any physical strain. A mass lesion was palpated on the calcaneus bone. MRI showed diffuse muscle involvement. The clinical picture was not consistent with infection or hematoma. The blood cell count and biochemical investigations were within normal limits. Serology for hepatitis B, C and HIV were negative. Biopsy was decided. Histological examination revealed CD19, CD20, bcl-2 and bcl-6 positive B-cell lymphoma with a Ki67 proliferation index of 95%. Myc, bcl-2, and bcl-6 gene rearrangements were not detected. Diffuse large B cell lymphoma was diagnosed. FDG-PET/CT showed lesions in multiple regions only limited to skeletal muscles but no other organ involvement. He had no adverse risk factors but bulky lesion (11cm sized lesion). After 6 courses of R-CHOP protocol, he had complete anatomic and metabolic response. Healthy skeletal muscles do not have lymphatic system. Lymphomatous involvement of muscles occurs by 3 pathways as dissemination via the haematogenous or lymphatic pathway, extension from adjacent organs, such as the bones or lymph nodes, and de novo primary extranodal disease. Most of the histology primary skeletal lymphomas have the aggressive B-cell immunophenoty. In general, treatment is similar to nodal lymphomas. In conclusion, we aimed to contribute in experience with this rare eNHL type.

Imaging features of skeletal muscle lymphoma: a case report and literature review

BackgroundDiffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), occurring predominantly in older people. Skeletal muscle lymphoma is a rare form of DLBCL, most frequently affecting the thigh, upper extremities, calf, and pelvis.Case presentationWe report a case of skeletal muscle DLBCL that was diagnosed using ultrasound (US)-guided biopsy. A 70-year-old man presented with progressive swelling and pain in the left lower extremity and an elevated erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP), ferritin, and CA125 levels. US, magnetic resonance imaging (MRI), and computed tomography (CT) showed diffuse lesions in several muscles of the left lower extremity. Positron emission tomography/CT (PET/CT) showed FDG-uptake in the affected muscles. The patient was treated with chemotherapy and achieved a good response. A systematic review of the literature published between 1992 and 2019 was conducted to investigate the role of imaging, including imaging-guided biopsy, in the diagnosis of skeletal muscle lymphoma.ConclusionsSkeletal muscle lymphoma is rare. US and MRI features include enlargement of muscular structures, with preservation of the architecture of the tissue and surrounding anatomical structures. Definitive diagnosis relies on histological and immunohistological analysis of a sample obtained through imaging-guided biopsy.

Primary Skeletal Muscle Lymphoma Disguised as Non-Resolving Cellulitis and Deep Venous Thrombosis: A Case Report and Literature Review

Primary Skeletal Muscle Lymphoma Disguised as Non-Resolving Cellulitis and Deep Venous Thrombosis: A Case Report and Literature Review

Primary Non-Hodgkin’s lymphoma originating from the masseter muscle

Recently, as we experienced a case of extranodal NHL originating from the masseter musclecompletely cured by chemotherapy with radiotherapy, we present the clinical, US, CT, andMR imaging findings in additional one case of biopsy-proved extranodal NHL (NK/T celllymphoma) involving predominantly the masseter muscle also review thoroughly our collectedcases of primary non-Hodgkin’s lymphoma involving the muscles of mastication and facialexpression. On the basis of our comprehensive review, we suggest two conclusions. First, primarymuscle lymphoma particularly originating from muscles of mastication and facial expression isextremely rare, but primary muscle lymphoma should be considered in the differential diagnosisof muscular masses. Second, primary muscle lymphoma particularly originating from muscles ofmastication and facial expression has similar clinical and radiological characteristics to primaryskeletal muscle lymphoma involving other sites. However, the prognosis is more favorablein primary muscle lymphoma originating from muscles of mastication and facial expressioncompared to primary skeletal muscle lymphoma involving other sites.
 Bangladesh Journal of Medical Science Vol.20(1) 2021 p.181-186

Skeletal Muscle Lymphoma Presenting with Chronic Compartment Syndrome of Leg after Trauma

Compartment syndrome may be acute or chronic based on the clinical course and etiology. Here, we report the first known case to be diagnosed with skeletal muscle-derived B-cell lymphoma presenting with chronic compartment syndrome after trauma. A 62-year-old woman sought medical attention due to a one-month history of painful left lower leg swelling and paresthesia of the medial side of the foot after falling over. The patient underwent fasciotomy and debridement under the preoperative diagnosis of fasciitis and myositis with associated compressive neuropathy. Preoperative laboratory tests were within normal limits. Postoperative pathologic examination and bone marrow aspiration revealed B-cell lymphoma with bone marrow involvement postoperatively. Tumor lysis syndrome took place, presenting with drowsiness, poor appetite, and oliguria, after the operation along with multiple organ failure. Awareness of the differential diagnoses of compartment syndrome in such clinical situation is crucial because it may lead to different examination and treatment plan preoperatively.

Primary skeletal muscle lymphoma: A case report.

Primary lymphomas of the bone or skeletal muscle are rare. Three mechanisms of lymphomatous involvement of the muscle have been described, namely direct invasion from adjacent involved lymph nodes or bone, metastatic spread and, least commonly, primary muscle lymphoma. We herein present a rare case of primary mucle non-Hodgkin lymphoma with a description if the associated clinicopathological findings and a review of the relevant literature. A 41-year-old female patient was referred to our hospital with a painful mass in the right lower extremity. Following resection and histopathological examination, a diffuse large B-cell lymphoma originating from the muscle with cutaneous and subcutanenous infiltration was diagnosed. The patient received chemotherapy with six cycles of cyclophosphamide, hydroxydaunomycin, oncovin and prednisone (CHOP regimen) and a complete radiological response was achieved after six cycles of treatment.

Positive imaging of primary NK/T lymphoma of skeletal muscle by 99Tcm-MIBI: a case report

Positive imaging of primary NK/T lymphoma of skeletal muscle by 99Tcm-MIBI: a case report

Myor/ABF-1 Mrna Expression Marks Follicular Helper T Cells but Is Dispensable for Tfh Cell Differentiation and Function In Vivo

Follicular T helper cells (Tfh) are crucial for effective antibody responses and long term T cell-dependent humoral immunity. Although many studies are devoted to this novel T helper cell population, the molecular mechanisms governing Tfh cell differentiation have yet to be characterized. MyoR/ABF-1 is a basic helix-loop-helix transcription factor that plays a role in the differentiation of the skeletal muscle and Hodgkin lymphoma. Here we show that MyoR mRNA is progressively induced during the course of Tfh-like cell differentiation in vitro and is expressed in Tfh responding to Alum-precipitated antigens in vivo. This expression pattern suggests that MyoR could play a role in the differentiation and/or function of Tfh cells. We tested this hypothesis using MyoR-deficient mice and found this deficiency had no impact on Tfh differentiation. Hence, MyoR-deficient mice developed optimal T-dependent humoral responses to Alum-precipitated antigens. In conclusion, MyoR is a transcription factor selectively up-regulated in CD4 T cells during Tfh cell differentiation in vitro and upon response to alum-protein vaccines in vivo, but the functional significance of this up-regulation remains uncertain.

Case report: a unique pediatric case of a primary CD8 expressing ALK-1 positive anaplastic large cell lymphoma of skeletal muscle

Primary involvement of skeletal muscle is a very rare event in ALK-1 positive anaplastic large cell lymphoma (ALCL). We describe a case of a 10-year old boy presenting with a three week history of pain and a palpable firm swelling at the dorsal aspect of the left thigh. Histological examination of the lesion revealed a tumoral and diffuse polymorphic infiltration of the muscle by large lymphoid cells. Tumor cells displayed eccentric, lobulated "horse shoe" or "kidney-shape" nuclei. The cells showed immunohistochemical positivity for CD30, ALK-1, CD2, CD3, CD7, CD8, and Perforin. Fluorescence in situ hybridization analysis revealed a characteristic rearrangement of the ALK-1 gene in 2p23 leading to the diagnosis of ALK-1 positive ALCL. Chemotherapy according to the ALCL-99-NHL-BFM protocol was initiated and resulted in a complete remission after two cycles. This case illustrates the unusual presentation of a pediatric ALCL in soft tissue with a good response to chemotherapy.

MRI Features of Skeletal Muscle Lymphoma

The purpose of this study was to assess the MRI findings of skeletal muscle lymphoma. MR images of pathologically proven lymphoma of skeletal muscle in 20 patients were retrospectively reviewed for the presence or absence of individual imaging findings. Nine patients had primary muscle lymphoma, and 11 patients had muscle metastasis from systemic lymphoma. The initial manifestation of skeletal muscle lymphoma was a muscle mass in 15 patients (75%) and abnormal muscle signal intensity in five patients (25%). Muscle enlargement was found in all cases. Long segmental involvement with orientation of the tumor along muscle fascicles was found in 15 patients (75%). Seventeen patients (85%) had traversing vessels within involved muscles. All of the tumors had equal to slightly increased signal intensity compared with normal muscle on T1-weighted images and intermediate signal intensity compared with fat on T2-weighted images. Among the 19 patients who underwent contrast-enhanced imaging, skeletal muscle lymphoma exhibited diffuse homogeneous enhancement in 13 patients (68%), predominantly peripheral thick bandlike enhancement in four patients (21%), and marginal septal enhancement in two patients (11%). Thick irregular enhancement of both deep and superficial fascia was found in 16 patients (84%), and one patient (5%) had deep enhancement only. Subcutaneous stranding was found in 16 patients (80%) and skin thickening in four patients (20%). Skeletal muscle lymphoma has distinctive MRI features that help differentiate it from other soft-tissue tumors and tumorlike lesions.

Long Term Survival of Primary Skeletal Muscle Lymphoma in a Miniature Dachshund

An 8-year-old miniature dachshund presented with a right femoral muscle mass and anorexia. Cytology of the mass revealed a number of small-sized lymphoid cells containing a pleomorphic-shaped dense nucleus and narrow pale cytoplasm. Histopathology indicated that neoplastic lymphoid cells proliferated in skeletal muscles and replaced the muscular architecture. Immunohistochemical and genetic examinations confirmed the diagnosis of primary skeletal muscle lymphoma classified as the pleomorphic small cell type and T-cell low-grade. Although the dog suffered at least three relapses by combination chemotherapy, the dog survived 713 days after the initial presentation.

Lymphoma‐Associated Polymyositis in Dogs

Lymphoma‐Associated Polymyositis in Dogs

Primary non-Hodgkin lymphoma of skeletal muscle: imaging findings

目的 分析原发性骨骼肌非霍奇金淋巴瘤(NHL)的影像学表现,以期提高对其的认识.方法 经病理证实的原发性骨骼肌NHL 5例,均为B细胞来源.其中3例有MR和CT检查,1例仅有CT检查,1例仅有MR检查.2例有X线平片,2例有核素骨显像.结果 所有患者均表现为受累肌肉弥漫性肿胀,肌肉轮廓可辨.4例CT平扫密度均匀,与未受累肌肉相近;增强扫描呈轻度强化2例,中等强化1例,强化密度均匀.MR扫描4例,平扫T1WI与周围肌肉相比呈稍低信号,T2WI信号明显高于周围未受累的肌肉.肿瘤内部的信号均匀,未见明显液化坏死区.增强扫描2例肿瘤为均匀强化,强化信号明显高于周围正常肌肉信号.X线平片2例显示骨质未被破坏.核素骨显像2例显示软组织肿块浓聚,骨髓的信号未见异常.结论 原发性骨骼肌NHL的影像学表现有一定的特点,MRI是其最佳的影像学检查方法。

Two cases of primary skeletal muscle lymphoma, and a review of the literature

Two cases of primary skeletal muscle lymphoma, and a review of the literature

Primary CD30/Ki-1 positive anaplastic large cell lymphoma of skeletal muscle with der(17)t(1;17)(q11;p11)

CD30/Ki-1 positive anaplastic large cell lymphoma (Ki-1 ALCL) frequently exhibits extranodal disease and chromosomal t(2;5)(p23;q35). An 11-year-old girl presented with an intramuscular tumor of the right upper arm. Tumors of the chest wall, left arm and leg, hepatomegaly, pleural effusion, and enlarged lymph nodes then developed. The intramuscular tumor and pleural effusion showed a diffuse infiltration of large atypical cells with abundant amphophilic cytoplasms. The tumor cells were positive for CD30, CD2, CD45RO, and p80, but were negative for other T-cell, B-cell, and myeloid cell antigens. She was diagnosed as having Ki-1 ALCL with a T-cell origin. Cytogenetic studies showed an abnormal karyotype including a der(17)t(1;17)(q11;p11). She received seven cycles of intensive chemotherapy followed by an autologous peripheral blood stem cell transplantation, and has been in complete remission for more than two years. The primary involvement of skeletal muscle is quite uncommon in ALCL, and an abnormal karyotype including t(1;17)(q11;p11) has not been reported previously. Since a high frequency of aberrations of 1p36/1q12 or 17p13.3 was detected in sarcoma cells, the presence of suppressor genes is suggestive in these sites.

Primary Anaplastic Large Cell Lymphoma of Skeletal Muscle Presenting with Compartment Syndrome

We describe a patient with primary anaplastic large cell lymphoma of the forearm presenting with compartment syndrome. Urgent decompression fasciotomy and combination chemotherapy resulted in durable remission status. This is followed by a review of primary skeletal muscle lymphoma in the English literature.

Localized muscle wasting as an initial symptom of skeletal muscle lymphoma

A 25-year-old man who developed painless muscle wasting and weakness of only the right thigh, was eventually shown to have systemic lymphoma with muscle infiltration. The patient was initially misdiagnosed as focal inflammatory myopathy, and he had a partial response to steroid therapy. Immunohistochemical analysis of the biopsied muscle and the subcutaneous tumor revealed the infiltrating cells with a positive macrophage-associated marker (CD68) and negative T- or B-cell-associated antigens, leading to the final diagnosis of true histiocytic lymphoma. Although skeletal muscle lymphoma is extremely rare, it should be considered in the differential diagnosis of localized muscle wasting.