Primary Synovial Diffuse Large B-Cell Lymphoma Presenting as Loosening of Prosthetic Joint: A Case Report and Review of Literature

Abstract

Primary synovial diffuse B-cell lymphoma is a rare clinical condition. The condition presents primarily with localized joint symptoms such as swelling, pain and reduced range of motion. It may or may not be associated with lymphadenopathy, hepatosplenomegaly or B-type constitutional symptoms. We report a case of a 74-year-old woman who presented with persistent left knee pain and swelling after left knee replacement secondary to osteoarthritis. There was a concern for mechanical loosening of internal left knee prosthetic joint. On revision surgery (14 weeks after the initial surgery), hypertrophied synovium with areas of fibrotic scars, necrotic tissue and dark colored masses was resected. She was found to have diffuse large B-cell lymphoma (DLBCL) after histological analysis. In cases with persistent joint symptoms or postoperative complications, arthroscopy or arthrotomy should be considered and any atypical appearing tissue should be sent for histopathological analysis.

Metallic implant-associated lymphoma: ALK-negative anaplastic large cell lymphoma associated with total knee replacement arthroplasty

“…Only seven cases of malignant lymphomas complicating total knee replacement arthroplasty have been reported in the medical literature [1][2][3][4][5][6][7]. The mean time between implantation of the prostheses and lymphoma diagnosis was 7 years (range, 6 months to 16 years).…”

“…Malignant lymphomas related to metallic implants from an orthopedic procedure, called metallic implant-associated lymphomas, are extremely rare [1]. Only seven cases of malignant lymphomas complicating total knee replacement arthroplasty have been reported and occur several years after operation; all cases were large B-cell lymphoma [1][2][3][4][5][6][7].…”

Primary cutaneous diffuse large B-cell lymphoma after total knee arthroplasty: a case study and a systematic review of its cutaneous manifestations and treatment options

“…Large B-cell lymphoma after knee arthroplasty is very rare, with only 8 other reported cases in the litera-ture (Supplementary Table S2) [33][34][35][36][37][38][39][40]. All of them were detected in the tissue around prosthesis, such as soft tissue, bone, synovium, and joint aspirate, whose histology was consistent with DLBCL or LBCL.…”

Diffuse Large B-Cell Lymphoma Discovered following Total Knee Arthroplasty: A Case Report and Literature Review

“…Visser et al [15] reported a similar case in a patient with autoimmune rheumatoid arthritis without any systemic symptoms. In another article, Agrawal et al [16] reported DLBCL in a patient 14 weeks post-total knee arthroplasty, when patient presented with loosening of the prosthetic joint.…”