Bone Involvement in Hodgkin’s Lymphoma: Clinical Features and Outcome

Gaudio, Francesco; Pedote, Pasquale; Asabella, Artor Niccoli; Ingravallo, Giuseppe; Sindaco, Paola Del; Alberotanza, Vito; Perrone, Tommasina; Laddaga, Filomena Emanuela; Rubini, Giuseppe; Ianora, Amato Antonio Stabile; Specchia, Giorgina

doi:10.1159/000490489

Cited by 23 publications

(22 citation statements)

References 14 publications

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“…The vascular approach was considered because a large proportion of PPL cases demonstrated sphenoidal involvement without bony erosion. Bony erosion happens in 8% of Hodgkin’s Lymphoma ( 44 ) cases and 15% in diffuse large B-cell lymphoma, which is less common at the early stage of the lymphoma system ( 45 ) but is still a viable way by which the tumor spreads to the sphenoidal area with or without visual changes in the sphenoidal bones. To the best of our knowledge, it is the first time that the characteristic of sphenoidal involvement is concluded for PPL, which might be different from other lymphomatous pathologies.…”

Section: Discussionmentioning

confidence: 99%

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

et al. 2021

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Primary pituitary lymphoma (PPL) represents an extremely rare entity. Here, we have reported two recently identified cases of immunocompetent PPL having diffuse large B-cell lymphoma by surgical biopsy. Both patients had hypopituitarism, with one patient developing right ptosis. In both patients, MRI and FDG-PET/CT depicted sellar mass that extended into the cavernous sinus with the right sphenoid also present in one of the patients. No systemic disease was found in these two patients. Surprisingly, we found that both patients had infiltrative lesions in sphenoid sinus mucosa pathologically, but the sphenoid bones that composed the sellar base were visually intact during the biopsy procedure. Chemotherapy was administered to both patients, where one patient achieved remission at the recent follow-up, whereas the other one did not respond to the treatment. The diagnosis of PPL is usually difficult if solely dependent on history, clinical presentation, biochemical indexes, and radiographic findings. We have also updated and reviewed the epidemiologic features, clinical presentations, pathological characteristics, potential mechanisms, therapeutic orientation, and prognostic advances of PPL. A total of 40 cases (including ours and four pediatric patients), histologically diagnosed, were analyzed in terms of clinical presentation, endocrine abnormality, radiological features, pathology, treatment, and follow-up. Hypopituitarism and headache were the most common presentation of PPL, while diabetes insipidus was reported in 13 patients (43.3%). B cell lymphoma was the most common type of pathology, followed by T-cell and NK/T cell. PPL was more invasive in nature at the suprasellar region (72.5%), cavernous sinus (52.5%), and sphenoidal sinus (27.5%) in 29, 21, and 11 patients, respectively. Pediatric patients with PPL seem to be different compared to their adult counterparts in terms of pathogenesis, clinical presentation, and radiological features. The management of PPL usually follows the treatment protocols for PCNSL but has a poor prognosis compared to the pituitary involvement of systemic lymphoma.

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Section: Discussionmentioning

confidence: 99%

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

et al. 2021

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“…1,5,6,8 When compared with non-Hodgkin lymphomas, HL involving marrow is relatively rare with an incidence of 3 to 18%. 1,[9][10][11] HL invariably arises in the lymph nodes, and primary extranodal HL is very rare. Isolated bone and bone marrow Hodgkin lymphoma is extremely rare, seen in less than 0.25% of cases, and very few case reports are reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Clinically Undetected Hodgkin Lymphoma Diagnosed Initially on Bone Marrow Biopsy: A Large Retrospective Observational Study from a Tertiary Care Center

Vangala

Paul

Uppin

et al. 2021

Indian J Med Paediatr Oncol

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Introduction Hodgkin lymphoma (HL) involving the bone marrow (BM) is relatively rare with an incidence ranging from 4% to 18%. The incidence of primary HL of marrow is 0.25%. To the best of our knowledge, the present study is the largest study on HL diagnosed initially on marrow biopsy. Objective To establish diagnostic criteria based on clinicopathological and histological features in HL diagnosed first on the marrow. Materials and Methods This was a retrospective study done from January 2012 to December 2020 that included 36 cases of HL diagnosed initially on BM. Based on the presence of large mononuclear or binucleate Reed–Sternberg (RS)-like cells in a polymorphous inflammatory background, HL was suspected and immunohistochemistry (IHC) with CD15 and CD30 was done. Correlation with subsequent lymph node biopsies was done, wherever possible. Results Fever (94.4%) was the most common symptom, followed by loss of weight (66.7%). Twenty-one cases (58.4%) had uni/bicytopenia and 15 cases (41.6%) had pancytopenia. Only one case showed suspicious mononuclear RS cells on aspirates and the rest of the cases were diagnosed on trephine biopsy alone. Trephine imprints showed variable cellularity in 13 (36%) cases. Diffuse involvement was seen in 24 cases (66.7%), and focal nodular aggregates were seen in 12 cases (33.3%). Out of 36 cases, 26 cases (19 cases on marrow and 7 cases on lymph node) were confirmed as HL with IHC. Immunophenotype of the RS cells on the marrow was CD30+/CD15+ in (6/29) (20.7%) cases, CD30+/CD15− in (7/29) (24.1%) cases and CD30−/CD15+ in (6/29) (20.7%) cases. Seven cases (26.9%) were diagnosed on subsequent lymph node biopsy as mixed cellularity HL with IHC confirmation. Marrow fibrosis was seen in 16 cases (44.4%), and granulomas were seen in 8 cases (22.2%). Conclusion In cases presenting with long-standing fever and cytopenias, HL must always be suspected, even if there are no palpable lymph nodes. Bone marrow biopsy is preferable over aspiration in such cases and IHC plays a major role in diagnosing the cases.

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“…On MRI, the signal in T1 and T2 sequences can be the same as for the muscle for HL bone lesions [20], while in fibrous dysplasia the signal is usually at low intensity in the T1 sequences and at high intensity in the T2 sequences [21]. The involved bone region could help address towards the correct diagnosis: a fibrous dysplasia usually affects the appendicular skeleton, femur, and tibia being the most common sites of involvement [6], while in HL the lesions are mainly axial [3]. Histologically, a fibrous dysplasia presents with trabeculae of immature bone merged in a fibrous stroma of dysplastic spindle-shaped cells, with a “Chinese writing type” pattern, without cortical involvement [22].…”

Section: Discussionmentioning

confidence: 99%

Polyostotic Fibrous Dysplasia Mimicking Bone Involvement in Hodgkin Lymphoma: A Pediatric Case and Literature Review

et al. 2020

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Bone involvement in Hodgkin lymphoma (HL) is rare. The differential diagnosis between HL bone localization and other malignant or benign skeletal diseases is challenging. We report the case of a girl affected by classic HL, initially staged IVA because of supradiaphragmatic lymph nodes and skeletal involvement. After 6 ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) cycles, positron emission tomography (PET) showed a complete metabolic response of the nodal localizations and a persistent, high metabolic activity of bone lesions. Salvage treatment followed by autologous stem cell transplant was carried out. After the transplant, the bone lesions maintained a high metabolic activity at PET. A targeted bone biopsy led to the diagnosis of a fibrous dysplasia excluding the presence of HL. To our knowledge, the concomitant presence of HL and fibrous dysplasia has not been previously reported. An in-depth evaluation of disease response to frontline treatment with a biopsy of the PET-hypercaptant bone lesions could have avoided overtreatment in this patient.

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Bone Involvement in Hodgkin’s Lymphoma: Clinical Features and Outcome

Cited by 23 publications

References 14 publications

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

Primary Pituitary Lymphoma in Immunocompetent Patients: A Report on Two Case Studies and the Review of Literature

Clinically Undetected Hodgkin Lymphoma Diagnosed Initially on Bone Marrow Biopsy: A Large Retrospective Observational Study from a Tertiary Care Center

Polyostotic Fibrous Dysplasia Mimicking Bone Involvement in Hodgkin Lymphoma: A Pediatric Case and Literature Review

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