Non-Hodgkin’s Lymphoma of the synovium discovered in total knee arthroplasty: a case report

Abstract

BackgroundMusculoskeletal involvement occurs in 25% of patients with non-Hodgkin’s lymphoma (NHL). Primary lymphoma in the joint is rare. It can present as a bone lesion or as atypical soft tissue proliferation. NHL has an increased incidence in patients with autoimmune rheumatic diseases.Case presentationWe present a case in which non-Hodgkin’s lymphoma was found coincidentally in the synovium during knee joint replacement surgery in a 69-year old woman with rheumatoid arthritis. Pigmented, vitreous tissue was resected, which turned out to be a diffuse large B-cell lymphoma after histological examination. The coincidental intraoperative finding of intra-articular non-Hodgkin’s lymphoma was reported twice before, presenting as synovial proliferation in elbow and shoulder surgery. In a few other cases non-Hodgkin’s lymphoma presented most often in the knee, as a bone lesion or, when soft tissue was involved, as arthritis.ConclusionNon-Hodgkin’s lymphoma should be considered in patients with autoimmune rheumatic diseases. In case of persistent arthritis, non-respondent to anti-inflammatory drugs, a biopsy might be warranted. Moreover, when arthroscopy or arthrotomy is planned, any atypical tissue should be sent for histological analysis. Early diagnosis of NHL can contribute to improved outcome of its rapidly developing treatment options.

Surgical Management of Primary Bone Lymphoma of the Hip: A Case Report and Review of the Literature

“…We note that this gentleman has a long history of hip osteoarthritis. Associations between rheumatoid arthritis and DLBCL have been made [ 11 ]; however, to date, no studies have reported association between osteoarthritis and DLBCL. Given the well-documented “wear and repair” nature of osteoarthritis [ 20 ] involving proinflammatory cytokines, many of which have been implicated in oncogenic pathways, we feel that molecular studies to investigate such an association are warranted.…”

“…PBL most commonly affects the femur; however, other skeletal sites may be involved including the innominatum, tibia, fibula, humerus, spine, mandible, radius, scapula, skull, talus, and synovium associated with the knee [ 6 , 10 , 11 ]. Patients with PBL most commonly present with pain but may also present with a fracture, localised swelling, or suspected periprosthetic joint infection [ 6 , 12 ].…”

“…Whilst the aetiology of PBL remains unknown, associations have been made with viral agents including human immunodeficiency virus and Epstein-Barr virus [ 15 , 16 ]. Furthermore, associations have been reported between PBL and chronic inflammation, for example, relating to joint prostheses and rheumatoid arthritis [ 11 , 12 , 17 ].…”

Monoartritis del codo e infarto óseo como presentación inicial de enfermedad linfoproliferativa

“…Respecto al linfoma, se ha reportado que entre 5-25% de los pacientes con linfoma no Hodgkin presentan manifestaciones musculoesqueléticas 2,3 . Entre ellas, la más frecuentemente reportada es el dolor óseo, y con menor frecuencia, la presencia de monoartritis, o poliartritis 2 .…”

Rare case of intra‐articular lymphoma of the knee arising from the Hoffa fat pad

“…There are case reports of lymphoma arising from the patella. There are also previous case reports of intra‐articular lymphoma being found at the time of joint replacement;6 however, these failed to specify the origin of the lesion. To our knowledge, this is the first case report of lymphoma originating within the Hoffa fat pad.…”