Primary lymphoma of the tibia in children

Abstract

Rationale: Primary lymphoma of the bones (PLB) is a rare extranodal non-Hodgkin lymphoma (NHL) that is particularly rare in children. The clinical presentation and radiological features of PLB are often nonspecific, making clinical diagnosis challenging and misdiagnosis frequent. Here, we report 2 children with PLB focusing on clinical presentation, differential diagnosis, and treatment outcomes. Patients concerns: A 9-year-old boy presented with left knee swelling and pain for 4 months after a fall. He was previously misdiagnosed with traumatic soft tissue injury. The second patient was an 11-year-old boy with a 6-month history of intermittent left knee pain. He was previously misdiagnosed with bone tuberculosis and chronic osteomyelitis. Diagnoses: A 9-year-old boy showed an abnormal signal of the left tibia metaphysis, diaphysis, and epiphysis, and tibia with periosteal reactions and surrounding soft tissue swelling. Tumor biopsy and immunohistochemistry confirmed a diagnosis of B-cell lymphoblastic lymphoma. An 11-year-old boy showed a permeative lesion in the metaphysis and diaphysis of the left proximal tibia. Tumor biopsy and immunohistochemistry confirmed the diagnosis of diffuse large B-cell lymphoma. Interventions: Both patients were treated with 6 courses of NHL-Berlin-Frankfurt-Münster-95. Outcomes: Both patients are in complete clinical remission with a follow-up of 27 and 18months after treatment, respectively. Lessons: PLB is a rare malignancy that is difficult to diagnose, particularly in children. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Chemotherapy combined with radiotherapy is a favorable treatment for children with PLB. Early diagnosis and active treatment can improve patient prognosis.

Non Hodgkin Lymphoma Among Children: Pathological Aspects and Diagnostic Challenges

“…Femur and pelvic bones represent the most common involved sites, and DLBL the most common histological subtype. 14 We have reported in the current study, 3 cases (2 DLBL and 1 T-LBL) presenting as multiple lytic lesions involving iliac bone in a 3; 4 and 6 years old boys. The diagnosis was challenging because of this unusual presentation, a large immunohistochemical panel was made to rule out the other differential diagnosis, including the other round cell pediatric’s tumors.…”