Malignant lymphoma of bone

Abstract

Malignant lymphoma of bone is rare. In many cases, its diagnosis is delayed because of unspecific clinical signs and equivocal radiographs. Therapy in general is multimodal, including surgery and radio- and chemotherapy. Our objective was to demonstrate the clinical and radiological aspects of the lesion to optimize diagnostic approaches and to evaluate treatment and prognostic factors. Thirty-six patients with malignant lymphoma of bone who were surgically treated over a 15-year-period were retrospectively reviewed. Seventeen of them showed a singular bone non-Hodgkin's lymphoma (NHL) which was classified as primary lymphoma of the bone (PLB). In 13 cases, dissemination of the disease with multiple bone or visceral involvement was apparent (dNHL). Six patients suffered from bone involvement due to Hodgkin's disease (HD). Surgical treatment was indicated for diagnostic reasons or complications due to the disease. Radiation and chemotherapy were part of the oncological treatment. The patients' mean age was 57 years. The main symptom in malignant bone lymphoma in 33 patients was pain, with an average duration of 8 months. In the secondary cases, bone involvement appeared on average 57 months after the initial diagnosis. An osteolytic pattern was seen in 58% of the lesions. Soft-tissue involvement was seen in 71% of cases (PLB 80%, dNHL 73%, HD 40%) and was the primary diagnostic sign associated with this disease. The 5-year survival rate was 61% (PLB 88%, dNHL 38%, HD 50%). Multiple vs solitary bone involvement was the most significant factor in the prognosis. Extraskeletal involvement significantly decreased survival. No correlation was found between gender, age, location, or histological subtypes and survival. Bone involvement in NHL appears late in the extraskeletal disease. The clinical appearance is nonspecific, and the delay between the onset of symptoms and diagnosis is often long. One of the major radiologic signs is the existence of a soft-tissue tumor surrounding the bone with little or no bone involvement on plain films. Treatment generally is conservative, based on the stage of the disease. Local radiation with or without systemic chemotherapy should be used. The long-term survival is favorable, but dependent on the stage of the disease and the amount of bone involvement.

A 38-year-old Man with Left Knee Pain

“…Presenting complaints are generally a localized, dull, aching pain. As many as 50% of patients will present after 1 year or more of symptoms [4]. Patients are generally otherwise healthy, and systemic complaints or B symptoms are rare [18,20].…”

“…Stage II disease refers to involvement of two or more sites on the same side of the diaphragm, Stage III disease is involvement of sites on both sides of the diaphragm or splenic involvement (Stage IIIS), and Stage IV disease represents disseminated involvement of organs (eg, liver, lungs, or bone marrow). Although differing series have suggested stage may [4,15] or may not [6,9] be prognostic, identifying all sites of disease is essential in ensuring appropriate radiotherapeutic and chemotherapeutic treatment and/or monitoring patients for relapse. Slightly greater than ½ of all patients with primary lymphomas of bone present with Stage IE disease [1,4,6,9,18].…”

“…As noted, stage does not consistently correlate with prognosis and this apparent discrepancy may be attributable to the tendency for patients with more advanced stage disease to receive more aggressive systemic chemotherapy, versus lower-dose chemotherapy or radiotherapy alone for many patients with early-stage disease. Histologic subtype may be prognostic, with classic, large B cell, cleaved-nuclei-type primary lymphoma of bone having increased survival relative to the noncleaved-nuclei type, immunoblastic and pleomorphic lymphomas, or Hodgkin's lymphoma [4,6,9]. Advanced age at presentation ([ 40-60 years) predicts higher diseasespecific mortality [6,9].…”

Metastatic non-Hodgkin lymphoma presenting as low back pain and radiculopathy: a case report

“…22 Primary bone lymphoma is exceedingly rare, accounting for only 3% of all primary bone malignancies. 23 Primary bone lymphoma may also present with LBP and radiculopathy as the initial manifestation of malignancy. [24][25][26] This case highlights the importance of STIR sequences as part of a routine lumbar spine MRI examination.…”

Ti̇bi̇al Pri̇mer Mali̇gn Lenfoma: Di̇rekt Grafi̇ Ve MRG Bulgulari

“…Yumuşak doku komponentinin ve kemik iliği tutulumunun değerlendirilmesinde MRG önemli rol oynar (4). Lezyon T1 ağırlıklı görüntülerde sıklıkla hipointens olarak izlenir.…”