Gluteal manifestation of advanced Hodgkin's disease

Abstract

Hodgkin's disease (HD) is a nodal malignancy with a characteristically axial pattern of spread and with contiguous progression via lymphatic channels. Even when dissemination occurs beyond the lymphoreticular system, certain patterns of associated spread are frequently evident. We describe a case of nodular sclerosis HD with a 12-year indolent course and late involvement of the gluteal muscle. Initially, stage was IVb with spleen and bone marrow involvement, complicated by a Coomb's positive hemolytic anemia. Following chemotherapy, the patient had a partial response with the subsequent long course of slowly progressive disease invading first the urinary bladder and, later, the gluteus. Involvement of the gluteal muscle is a rare event in HD. Spread to the gluteus occurred most likely by contiguity, via retroperitoneal lymph nodes.

Extranodal lymphoma originating in the gluteal muscle with adjacent bone involvement and mimicking a soft tissue sarcoma

“…Common sites for the development of ENL are the skin, head, neck and gastrointestinal tract; primary lymphoma of the skeletal muscle is extremely rare [1–4] . To date, only a few cases of malignant lymphoma originating in the gluteal muscle have been reported in the English literature [5,7,9,10] . Textbooks present the common aspects of ENL in detail, but the published literature on the unexpected manifestations of NHL, such as soft tissue masses invading adjacent structures, is inadequate.…”

“…However, extranodal lymphoma (ENL) in the muscles as an isolated manifestation is very rare, accounting for 1.5–8.3% of non-Hodgkin lymphoma (NHL) cases [4–6] . Clinically, the presence of cortical bone destruction in association with large soft-tissue masses arising in the skeletal muscle, favors the diagnosis of soft tissue sarcoma, malignant musculoskeletal tumor such as malignant fibrous histiocytoma (MFH), malignant neurogenic tumor (MPNST) or metastasis rather than malignant lymphoma [3,4,7,8] .…”

Lymphoma at uncommon sites

“…290 Bone Approximately 20 per cent of patients with Hodgkin's disease are said to have radiographic bone involvement 291 with this figure rising to 60 per cent in an autopsy series. 292 The axial skeleton is involved in over 75 per cent of cases, with the spine the most common site, and needless to say, radiology and imaging play a large part in assessing bone involvement.…”