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Ahmadullah, Bilal M, Khan Y. Pattern of Clinical Presentation in Patients With Lymphoma. Cureus 2024; 16:e62211. [PMID: 39011218 PMCID: PMC11249278 DOI: 10.7759/cureus.62211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction Lymphomas take place when cells of the lymphatic system divide and re-divide in an uncontrolled fashion, and lymphomas have been termed as a "diverse group" of cancer, playing a major role in the area of oncology. The clinical behavior and manifestations of lymphomas in the head and neck region usually lack specific characteristics that would enable attribution to a specific lymphoma entity without biopsy and histological evidence. This study aimed to determine the frequency of common clinical features among patients with lymphoma. Methods This descriptive cross-sectional study was conducted at the Department of General Medicine, Lady Reading Hospital, Peshawar, from October 28, 2021 to April 28, 2022. The inclusion criteria consisted of individuals who were recently diagnosed with lymphoma and were between the ages of 10 and 50, regardless of their gender. This study enrolled a total of 186 patients diagnosed with lymphoma and assessed for common signs and symptoms. The data-gathering process included in-depth interviews, evaluations of medical history, physical exams, and initial investigations. The data analysis was done using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Results The mean age of the patients was 34.5±9.6 years. Out of the total, 115 (61.8%) were men and 71 (38.2%) were women. With regard to symptoms, 134 (72%) had a fever, 80 (43%) had abdominal pain, 102 (54.8%) had vomiting, 49 (26.3%) had a headache, 111 (59.7%) had weight loss, and 17 (9.1%) had a cough. With regard to signs, 33 (17.7%) had painless lymphadenopathy, 58 (31.2%) had jaundice, 157 (84.4%) had anemia, 147 (79%) had hepatomegaly, 160 (86%) had splenomegaly, 24 (12.9%) had ascites, and 16 (8.6%) had abdominal tenderness. Conclusion The varied clinical appearance of lymphoma makes treatment difficult. In severe cases of lymphoma, early and timely diagnosis is crucial for proper and prompt treatment. The signs and symptoms, along with demographic information of patients, thorough medical history, imaging testing, and clinical examination, may indicate lymphoma.
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Affiliation(s)
- Ahmadullah
- Department of Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Muhammad Bilal
- Department of Internal Medicine, Lady Reading Hospital, Peshawar, PAK
| | - Yaseen Khan
- Department of Internal Medicine, Lady Reading Hospital, Peshawar, PAK
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2
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Zheng G, Yang Z, Qian H, Huang H, Gu Z. Conditional survival of patients with primary bone lymphoma of the spine: how survival changes after initial diagnosis. Front Oncol 2024; 14:1356947. [PMID: 38751818 PMCID: PMC11094224 DOI: 10.3389/fonc.2024.1356947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background The current survival prediction methodologies for primary bone lymphoma (PBL) of the spine are deficient. This study represents the inaugural utilization of conditional survival (CS) to assess the outcome of this disease. Moreover, our objective was to devise a CS-based nomogram for predicting overall survival (OS) in real-time for spinal PBL. Methods Patients with PBL of the spine diagnosed between January 2000 and December 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The OS was determined through the Kaplan-Meier method. The CS characteristic of patients with spinal PBL was delineated, with the CS being estimated utilizing the formula: CS(α|β) = OS(α+β)/OS(β). CS(α|β) denotes the probability of additional α-year survivorship, assuming the patient has already survived β years after the time of observation. Three methods including univariate Cox regression, best subset regression (BSR) and the least absolute shrinkage and selection operator (LASSO) regression were used to identify predictors for CS-based nomogram construction. Results Kaplan-Meier analysis was executed to determine the OS rate for these patients, revealing a survival rate of 68% and subsequently 63% at the 3-year and 5-year mark respectively. We then investigated the CS patterning exhibited by these patients and discovered the survival of PBL in the spine progressively improved with time. Meanwhile, through three different prognostic factor selection methods, we identified the best predicter subset including age, tumor histology, tumor stage, chemotherapy and marital status, for survival prediction model construction. Finally, we successfully established and validated a novel CS-based nomogram model for real-time and dynamic survival estimation. Moreover, we further designed a risk stratification system to facilitate the identification of high-risk patients. Conclusions This is the first study to analyze the CS pattern of PBL of the spine. And we have also developed a CS-based nomogram that provide dynamic prognostic data in real-time, thereby aiding in the formulation of personalized treatment strategies in clinical practice.
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Affiliation(s)
| | | | | | | | - Zhiwei Gu
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China
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3
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Panagopoulos A, Solou K, Symeonidis A, Verigou E, Kouroukli O, Zolota V, Kokkalis ZT. Delayed diagnosis of a primary diffuse large B-cell lymphoma of the humeral head, presenting as pathological fracture: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:299-311. [PMID: 38706663 PMCID: PMC11065756 DOI: 10.1016/j.xrrt.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Andreas Panagopoulos
- Department of Orthopaedics, University Hospital of Patras, Medical School, Patras, Greece
| | - Konstantina Solou
- Department of Orthopaedics, University Hospital of Patras, Medical School, Patras, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Medical School, Patras, Greece
| | - Evgenia Verigou
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Medical School, Patras, Greece
| | - Olga Kouroukli
- Department of Pathology, University Hospital of Patras, Medical School, Patras, Greece
| | - Vasiliki Zolota
- Department of Pathology, University Hospital of Patras, Medical School, Patras, Greece
| | - Zinon T. Kokkalis
- Department of Orthopaedics, University Hospital of Patras, Medical School, Patras, Greece
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Wang C, Kaur K, Xu C, Abu-Amer Y, Mbalaviele G. Chemotherapy activates inflammasomes to cause inflammation-associated bone loss. eLife 2024; 13:RP92885. [PMID: 38602733 PMCID: PMC11008812 DOI: 10.7554/elife.92885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Abstract
Chemotherapy is a widely used treatment for a variety of solid and hematological malignancies. Despite its success in improving the survival rate of cancer patients, chemotherapy causes significant toxicity to multiple organs, including the skeleton, but the underlying mechanisms have yet to be elucidated. Using tumor-free mouse models, which are commonly used to assess direct off-target effects of anti-neoplastic therapies, we found that doxorubicin caused massive bone loss in wild-type mice, a phenotype associated with increased number of osteoclasts, leukopenia, elevated serum levels of danger-associated molecular patterns (DAMPs; e.g. cell-free DNA and ATP) and cytokines (e.g. IL-1β and IL-18). Accordingly, doxorubicin activated the absent in melanoma (AIM2) and NLR family pyrin domain containing 3 (NLRP3) inflammasomes in macrophages and neutrophils, causing inflammatory cell death pyroptosis and NETosis, which correlated with its leukopenic effects. Moreover, the effects of this chemotherapeutic agent on cytokine secretion, cell demise, and bone loss were attenuated to various extent in conditions of AIM2 and/or NLRP3 insufficiency. Thus, we found that inflammasomes are key players in bone loss caused by doxorubicin, a finding that may inspire the development of a tailored adjuvant therapy that preserves the quality of this tissue in patients treated with this class of drugs.
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Affiliation(s)
- Chun Wang
- Division of Bone and Mineral Diseases, Washington University School of MedicineSt. LouisUnited States
| | - Khushpreet Kaur
- Division of Bone and Mineral Diseases, Washington University School of MedicineSt. LouisUnited States
| | - Canxin Xu
- Aclaris Therapeutics, IncSt. LouisUnited States
| | - Yousef Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of MedicineSt. LouisUnited States
- Shriners Hospitals for ChildrenSt. LouisUnited States
| | - Gabriel Mbalaviele
- Division of Bone and Mineral Diseases, Washington University School of MedicineSt. LouisUnited States
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Ghione P, Ahsanuddin S, Luttwak E, Varela SB, Nakajima R, Michaud L, Gupta K, Navitski A, Straus D, Palomba ML, Moskowitz A, Noy A, Hamlin P, Matasar M, Kumar A, Falchi L, Yahalom J, Horwitz S, Zelenetz A, Younes A, Salles G, Schöder H, Joffe E. Diffuse large B-cell lymphoma involving osseous sites: utility of response assessment by PET/CT and good longterm outcomes. Haematologica 2024; 109:200-208. [PMID: 37646672 PMCID: PMC10772505 DOI: 10.3324/haematol.2022.282643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 08/25/2023] [Indexed: 09/01/2023] Open
Abstract
Osseous involvement by diffuse large B-cell lymphoma (DLBCL-bone) is a heterogeneous disease. There is limited data regarding response assessment by positron emission tomography with fluorodeoxyglucose, which may demonstrate residual avidity despite a complete response. We analyzed clinical data of patients with newly diagnosed DLBCL and identified all cases with DLBCL-bone. End of treatment scans were reviewed by two independent experts classifying osseous lesions into Deauville (DV) ≤3; DV ≥4, or reactive uptake in the bone marrow (M), site of fracture (F) or surgery (S). We compared outcomes of DLBCL-bone to other extranodal sites (EN) matched on International Prognotic Index features and regimen. Of 1,860 patients with DLBCL (bone 16%; EN 45%; nodal 39%), 41% had localized disease and 59% advanced. Only 9% (n=27) of patients with initial bone involvement had residual fluorodeoxyglucose avidity at the osseous site. In half of these cases, the uptake was attributed to F/S/M, and of the remaining 13, only two were truly refractory (both with persistent disease at other sites). Overall survival and progression-free survival (PFS) were found to be similar for early- stage nodal DLBCL and DLBCL-bone, but inferior in EN-DLBCL. Advanced-stage disease involving the bone had a similar 5-year PFS to nodal disease and EN-DLBCL. After matching for International Prognotic Index and treatment regiments, PFS between bone and other EN sites was similar. Osseous involvement in DLBCL does not portend a worse prognosis. End of treatment DV ≥4 can be expected in 5-10% of cases, but in the absence of other signs of refractory disease, may be followed expectantly.
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Affiliation(s)
- Paola Ghione
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine.
| | | | - Efrat Luttwak
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | | | - Reiko Nakajima
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Laure Michaud
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Kanika Gupta
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | | | - David Straus
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - M Lia Palomba
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Alison Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Ariela Noy
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Paul Hamlin
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Matthew Matasar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Anita Kumar
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Lorenzo Falchi
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Joachim Yahalom
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center
| | - Steven Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Andrew Zelenetz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Anas Younes
- Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Gilles Salles
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell College of Medicine
| | - Heiko Schöder
- Weill Cornell College of Medicine, New York, NY; Radiation Therapy, Memorial Sloan Kettering Cancer Center
| | - Erel Joffe
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY; Sackler School of Medicine, Aviv University.
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Yohannan B, Rios A. Primary Diffuse Large B-Cell Lymphoma of the Bone. J Hematol 2023; 12:75-81. [PMID: 37187495 PMCID: PMC10181325 DOI: 10.14740/jh1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/27/2023] [Indexed: 05/17/2023] Open
Abstract
Primary lymphoma of the bone (PLB) is a rare lymphoproliferative neoplasm that can present either as solitary or multiple bone lesions. We report four patients with PLB who were successfully treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by consolidative radiotherapy. All patients achieved a complete remission and had excellent long-term outcomes. PLB has a favorable response to combined modality treatment with chemoimmunotherapy and radiation. Long-term outcomes of PLB tend to be better than those of non-osseous diffuse large B-cell lymphoma.
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Affiliation(s)
- Binoy Yohannan
- Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adan Rios
- Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Corresponding Author: Adan Rios, Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Khan AQ, Qamar R, Chowdhry M, Siddiqui B, Khan SM, Gupta D. Extranodal Diffuse Large B-Cell Lymphoma (DLBCL) Presenting as Diffuse Joint Pain: A Diagnostic Dilemma. Indian J Orthop 2023; 57:603-607. [PMID: 37006730 PMCID: PMC10050486 DOI: 10.1007/s43465-023-00831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
Diffuse Large B-Cell Lymphoma (DLBCL) of bone is a rare presentation of Non-Hodgkin Lymphoma (NHL), which remains asymptomatic or present late in clinical course as bone pain or pathological fracture. We report a case of a 15-year-old male child presenting with diffuse joint pain and swelling over his left shoulder and elbow, associated with B symptoms. Radiological examination revealed lytic lesions in multiple bones along with collection along the left iliopsoas and hip joint, suggestive of infective etiology. The diagnostic dilemma was resolved on biopsy, which confirmed DLBCL involving bones and soft tissue.
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Affiliation(s)
- Abdul Qayyum Khan
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Rayed Qamar
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Madhav Chowdhry
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Bushra Siddiqui
- Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Saad Mohammad Khan
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
| | - Divas Gupta
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh 202002 India
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8
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Primary Bone Lymphoma: A Review of the Literature with Emphasis on Histopathology and Histogenesis. Diseases 2023; 11:diseases11010042. [PMID: 36975591 PMCID: PMC10047712 DOI: 10.3390/diseases11010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Primary bone lymphoma (PBL) is a rare neoplasm of malignant lymphoid cells presenting with one or more bone lesions without nodal or other extranodal involvement. It accounts for approximately 1% of all lymphomas and 7% of malignant primary bone tumors. Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) represents the predominant histological type and constitutes over 80% of all cases. PBL may occur at all ages with a typical diagnosis age of 45–60 years and a slight male predominance. Local bone pain, soft tissue edema, palpable mass and pathological fracture are the most common clinical features. Diagnosis of the disease, which is frequently delayed due to its non-specific clinical presentation, is based on the combination of clinical examination and imaging studies and confirmed by combined histopathological and immunohistochemical examination. PBL can develop in any part of the skeleton, although it occurs most commonly in the femur, humerus, tibia, spine and pelvis. The imaging appearance of PBL is highly variable and unspecific. In terms of the cell-of-origin, most cases of primary bone DLBCL (PB-DLBCL), NOS belong to the germinal center B-cell-like subtype and specifically originate from germinal center centrocytes. PB-DLBCL, NOS has been considered a distinct clinical entity based on its particular prognosis, histogenesis, gene expression and mutational profile and miRNA signature. PBL carries a favorable prognosis, especially when treated with combined chemoradiotherapy.
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Wu Z, Teng Y, Wu J, Zhang H, Peng W, Meng C, Tang W, Feng J. Clinical use of HD-MTX monotherapy in a rare case of refractory primary bone diffuse large B-cell lymphoma with long-term survival after local radiotherapy: A case report. Front Med (Lausanne) 2022; 9:989590. [PMID: 36619626 PMCID: PMC9810803 DOI: 10.3389/fmed.2022.989590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) has been rarely reported because of its low incidence. The optimal treatment plan for patients with relapsed/refractory PB-DLBCL remains controversial. In this study, we present a case of a 57-year-old patient with refractory PB-DLBCL to better understand this disease. The patient developed lumbosacral/low extremity pain. A lumbar magnetic resonance imaging (MRI) revealed skeletal lesions with osteolysis in L4-L5 and S1. With the failure of multi-line chemotherapy, the patient developed paralysis of both lower limbs. 18-Fluorinefluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and MRI showed new lesions in the femoral head, cervical and thoracic vertebrae. We tried to treat the patient with adjuvant radiotherapy and 10 courses of high-dose methotrexate (HD-MTX)-based monotherapy, after which the patient was able to walk and achieved complete remission (CR). To the best of our knowledge, this is the first attempt to use local radiotherapy combined with an HD-MTX regimen successfully for the treatment of refractory PB-DLBCL.
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Affiliation(s)
- Zhiya Wu
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yue Teng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jianqiu Wu
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Honglu Zhang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Weiwei Peng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Cheng Meng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Weiyan Tang
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,*Correspondence: Weiyan Tang,
| | - Jifeng Feng
- Department of Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China,Jifeng Feng,
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Horner KJ, Smith CJ, Laziuk K, Summerhays B. Chronic Heel Pain Found to Be Diffuse Large B-cell Lymphoma of the Calcaneus. Cureus 2022; 14:e25282. [PMID: 35755567 PMCID: PMC9219595 DOI: 10.7759/cureus.25282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Primary non-Hodgkin lymphoma of the bone is quite rare, accounting for less than 2% of all lymphomas in adults. We present a unique case of chronic left heel pain in a 34-year-old pregnant woman with a remote history of lower extremity trauma. Unresponsive to conservative treatment, advanced imaging showed an infiltrative soft tissue mass involving the calcaneus and surrounding soft tissues. Biopsy of the area confirmed the diagnosis of Stage I-AE diffuse large B-cell lymphoma. The patient underwent 20 localized radiation treatments to the left heel. Nine years after the diagnosis, the patient remains in remission without signs of disease recurrence. This case report demonstrates that atypical and less common causes of chronic heel pain should be considered in certain clinical scenarios, especially in those unresponsive to conservative treatment.
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Jalloh HB, Ahlawat S, Gross JM, Levin AS, Schaefer RA. Primary Lymphoma of the Distal Femur Presenting as Spontaneous Deep Vein Thrombosis and Knee Monoarthritis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00114. [PMID: 37556822 DOI: 10.2106/jbjs.cc.21.00402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
CASE A 68-year-old man with a history of unprovoked deep vein thrombosis (DVT) presented with recurrent knee effusions after the initiation of anticoagulation. Radiographs showed soft-tissue swelling without a distinct skeletal lesion. Magnetic resonance imaging, however, showed a marrow-replacing process in the distal femur. Subsequent biopsy demonstrated B-cell lymphoma. CONCLUSION This is a rare case of a primary lymphoma of bone mimicking synovial disease. It also highlights the fact that an unprovoked DVT may be a harbinger of an undiagnosed underlying malignancy.
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Affiliation(s)
- Hulaimatu B Jalloh
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Shivani Ahlawat
- Department of Radiology, The Johns Hopkins University, Baltimore, Maryland
| | - John M Gross
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland
| | - Adam S Levin
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Richard A Schaefer
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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