Diffuse Large B Cell Lymphoma Complicating Total Knee Arthroplasty: Case Report and Literature Review of the Association of Diffuse Large B Cell Lymphoma with Joint Replacement

Abstract

Primary lymphoma of bone is extremely rare. There are increasing reports of lymphoma arising in bone adjacent to metallic prostheses. Herein, we describe the case of a 76-year-old man who developed diffuse large B cell lymphoma in the tibia 3 years after total knee arthroplasty for osteoarthritis. A review of the literature has identified 11 other cases of lymphoma arising in the context of orthopaedic metallic implants. To our knowledge this is the first reported case of a primary lymphoma arising in bone adjacent to a knee prosthesis. Possible pathogenetic mechanisms may include chronic antigenic stimulation of lymphocytes, proliferation of EBV-infected B lymphocytes, and direct mutagenic effects of metallic ions. Further research is required to investigate this intriguing link between metallic orthopaedic prostheses and localized lymphoma.

Case Report: Epstein-Barr-Virus negative diffuse large B-cell lymphoma detected in a peri-prosthetic membrane

“…The carcinogenic effects of the metallic components and wear particles are not yet fully elucidated [ 7 ]. Most cases reported in this context are DLBCL associated with chronic inflammation and concomitant EBV infection [ 2 , 7 ]. Campo et al report, that in these lesions lymphomas-infected cells frequently express a latency type 3 with positivity for the viral proteins latent membrane protein 1 and EBV nuclear antigen 2, suggesting, that the lymphoid proliferation may be related primarily to a decrease in the host immune-surveillance [ 5 ].…”

“…Our described case of DLBCL, however, lacks EBV infection and is localized to the knee without any other site of involvement. A summary of our literature search (see Table 1 ) showed only one case of diffuse large B-cell lymphoma in association with a joint replacement without EBV association and was published in 2011 [ 2 ]. Another case was reported with negativity for the EBV in situ hybridization, but positivity for EBV in the polymerase chain reaction [ 7 ].…”

“…Lymphoma is the seventh most common systemic malignancy worldwide [ 1 , 2 ]. DLBCL is the most common aggressive Non-Hodgkin Lymphoma (NHL) [ 3 ] and in addition the most common type of PBL [ 4 ].…”

“…DLBCL is the most common aggressive Non-Hodgkin Lymphoma (NHL) [ 3 ] and in addition the most common type of PBL [ 4 ]. Over the last decades, the use of joint replacement surgery, such as total hip and total knee arthroplasty, has increased [ 2 ]. Despite this fact lymphomas developed within the peri-prosthetic membrane are exceedingly rare.…”

A deceptive case of gastric carcinoma with lymphoid stroma

“…Some studies have suggested there may be a cohort of metallic-joint prosthetic related lymphomas which could be likened to the well-recognised breast-implant associated anaplastic large cell lymphoma (ALCL). 3 This case discussion highlights the need for further international cohort studies that include a broad analysis of potential patient and prosthetic specific risk factors for malignancy.…”