Sacral pain as the initial symptom in primary Hodgkin′s lymphoma of bone

Abstract

Progressive painless enlargement of peripheral lymph nodes is the most common presentation of Hodgkin's lymphoma. The bone involvement is seen particularly in the later stages, but very rarely in early stages of the disease. Primary osseous Hodgkin lymphoma is exceedingly rare. Here, we report a case of Primary osseous Hodgkin lymphoma in a 35-year-old male presenting with osteolytic lesions of iliac and sacral bone without other symptoms. Histopathology examination revealed Hodgkin's disease. All other investigations (including computed tomography of the chest, abdomen and pelvis, bone marrow aspiration) were negative for occult disease. Polychemotherapy was started and the symptoms resolved. The case report highlights the importance of clinical suspicion of primary Hodgkin lymphoma of the bone, especially those involving the pelvis bones.

Definition of cortical bone involvement in the staging of newly diagnosed pediatric Hodgkin lymphoma: A report from the International Working Group on Staging Evaluation and Response Criteria Harmonization (SEARCH)

“…36 In another report, plain film findings with increased radionucleotide tracer uptake on Tc-99m bone scan or histologic examination met the criteria for involvement, 27 but CT evidence alone was considered sufficient in three other papers. 11,13,37 In an additional three reports, CT evidence required histopathologic confirmation from a biopsy, 9,15,38 whereas one study used MRI findings alone. 39 The remainder of the reports used FDG-PET findings to determine cortical bone involve- 11 In that study, a diagnosis of cortical bone involvement was suspected based on CT scan findings with confirmatory testing by a bone scan, conventional radiographs, MRI, or a PET scan; biopsies were not performed.…”

“…An additional question remains as to whether multifocal cortical bone disease represents more advanced disease and should, therefore, be staged and treated accordingly. There are no guidelines regarding the use of chemotherapy versus radiotherapy or a combination of the two in cases of isolated or multifocal bony lesions . It does not appear that one treatment modality is superior to another or to a combination of chemotherapy and radiotherapy, as all the case reports reviewed reported favorable outcomes regardless of the treatment chosen.…”

“…The most frequently used regimen (n = 10) was adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). 6,9,13,31,33,34,37,38 Ten patients received chemotherapy alone, 7,9,13,29,31,33,34,37,38,43 whereas six received combined modality treatment with chemotherapy and radiation. 6,13,15,32,33 One report did not mention the treatment used, nor did it comment on survival.…”

“…There are no guidelines regarding the use of chemotherapy versus radiotherapy or a combination of the two in cases of isolated or multifocal bony lesions. [32][33][34][35][36][37][38][39]43 It does not appear that one treatment modality is superior to another or to a combination of chemotherapy and radiotherapy, as all the case reports reviewed reported favorable outcomes regardless of the treatment chosen.…”

Classic Hodgkin lymphoma in pelvis

“…It seems that primary bone HL most likely appears on spine or long bone, seldom occurs in pelvic (Table 2 ). [ 5 , 6 , 8 , 13 , 19 – 33 ] Nodular sclerosis CHL represents 70% of CHL in Europe and USA, and this figure in China is 32.6%. [ 34 ] Almost 54% of nodular sclerosis CHL cases present with a huge soft mass.…”