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Kahn E, Nomani L, Harrington AM, Asmi N. Primary Bone Lymphoma Masquerading as Multiple Myeloma: Challenges in the Diagnostic Workup of Severe Hypercalcemia. Cureus 2024; 16:e51856. [PMID: 38327974 PMCID: PMC10848882 DOI: 10.7759/cureus.51856] [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] [Accepted: 12/20/2023] [Indexed: 02/09/2024] Open
Abstract
In this case, we explore the diagnostic workup of a patient presenting with symptomatic hypercalcemia. Initially suspected to have multiple myeloma, the diagnostic evaluation instead unveiled non-germinal center (non-GC) diffuse large B-cell lymphoma (DLBCL). DLBCL is the most common histologic subtype of non-Hodgkin lymphoma and is heterogeneous in terms of presentation, genetic drivers, and morphology. As primary bone DLBCL is exceedingly rare, the case presented proved to be a diagnostic challenge. The patient presented with one week of weakness, one to two days of nausea, and leg pain. On admission, hypercalcemia, renal failure, anemia, and lytic bone lesions were present and suggestive of multiple myeloma. However, serum protein electrophoresis and immunoglobulin levels did not fit the 2016 World Health Organization (WHO) diagnostic criteria for multiple myeloma. A negative bone marrow biopsy also argued against a diffuse plasma cell neoplasm. Finally, a biopsy from another bone lesion was diagnostic of DLBCL. This case discusses an unusual presentation of DLBCL.
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Affiliation(s)
- Elise Kahn
- Department of Internal Medicine, University of Colorado, Aurora, USA
- Department of Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
| | - Laila Nomani
- Department of Pathology, Medical College of Wisconsin, Wauwatosa, USA
| | | | - Nisar Asmi
- Section of Hospital Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
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Role of 18F-fluorodeoxyglucose PET/computed tomography in the diagnosis and treatment response assessment of primary bone lymphoma. Nucl Med Commun 2023; 44:318-329. [PMID: 36722755 PMCID: PMC9994810 DOI: 10.1097/mnm.0000000000001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Primary bone lymphoma (PBL) is a rare type of extranodal lymphoma, and the clinical application value of 18F-fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) in PBL has not been fully evaluated. This study aimed to determine the imaging characteristics of PBL and investigate the value of 18 F-FDG PET/CT parameters. METHODS A total of 25 patients with PBL who underwent PET/CT examination before treatment were included in this study. The clinicopathological parameters and PET/CT parameters were analyzed. RESULTS Among the 25 patients, 7 patients had single lesions, 15 patients had nonsingle lesions (≥2) and 3 patients had diffuse distribution in the medullary cavity. The bone destruction types included osteolytic, osteogenic, normal density, mixed lytic and osteogenic. All patients showed increased FDG uptake, and the CT detection rate was 88%. Five patients underwent PET/CT assessment mid-treatment, and when assessed using the Deauville five-point scale, four patients were PET-negative and one patient was PET-positive. There were two PET-positive and three PET-negative patients when assessed using the Δ maximum standardized uptake value (SUV max ) method. Six patients underwent PET/CT imaging at the end of treatment. When assessed using the Deauville five-point scale, five patients (83%) were PET-negative and one patient (17%) was PET-positive. The same results were obtained when evaluated by the ΔSUV max method. CONCLUSION PET/CT plays a substantial role in the diagnosis and treatment efficacy evaluation of PBL, and it should be recognized by clinicians and radiologists. Changes in metabolic parameters such as SUV, metabolic tumor volume and total lesion glycolysis have considerable potential for application in PBL diagnostics and treatment efficacy evaluation.
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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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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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Mahajan R, Yadav BS, Sharma SC, Gupta A, Kumar S. Primary Bone Lymphoma: An Experience of a Regional Cancer Center from India. South Asian J Cancer 2021; 9:227-229. [PMID: 34131574 PMCID: PMC8197650 DOI: 10.1055/s-0040-1721173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background
Primary bone lymphoma (PBL) is a rare disease, representing <5% of all extranodal non-Hodgkin’s lymphomas (NHLs). The optimal treatment strategy is still unclear. Here, we report our institutional outcome analysis of patients diagnosed with PBL.
Materials and Methods
From 2007 to 2014, the medical records of 22 patients with PBL were reviewed. Analysis was done for symptom-, patient-, disease-, and treatment-related characteristics. All patients were treated with chemotherapy with or without radiotherapy. Treatment response and impact of different prognostic factors on clinical outcome were analyzed.
Results
The median age of presentation was 44 years (range: 18–70 years). A total of 19 (86.4%) patients were ≤60 years of age and 3 (13.6%) patients were >60 years. Out of all, 18 were males and 4 were females. Ann Arbor clinical staging at diagnosis was Stage I in 13 (59.1%), Stage II in 3 (13.6%), Stage III in 2 (9.1%), and Stage IV in 4 (18.2%) patients. Spine was the most common site of involvement seen in 12 (54.5%) patients. Diffuse large B cell lymphoma histology was seen in 8 (36.4%) patients and 8 (36.4%) had high-grade NHL. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone was given to 20 (90.9%) patients, whereas 2 (9.1%) patients received cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab. Radiotherapy (30-40 Gy) was delivered to 19 (86.4%) patients. The median follow-up period was 40 months (range: 8–105 months). The overall response rate was 86.3% with complete response (CR) in 15 (68.1%) and partial response in 4 (18.2%) patients. Relapses were seen in three (13.5%) patients: two nodal, and one in the bone. Disease-free survival (DFS) and overall survival (OS) at 5 years were 56.6 and 72.7%, respectively. CR after initial treatment was associated with a significant better OS, 80 and 25%, respectively (
p
< 0.0001). Age, sex, stage, International Prognostic Index, histologic subtype, and number of sites had no significant influence on OS. Combining radiation therapy with chemotherapy (with or without rituximab) also did not improve the OS or DFS of patients.
Conclusion
In spite of small number of patients reported in this study, conventional chemotherapy remains an effective treatment option for patients with PBL. OS was found to be affected by the initial response to treatment.
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Affiliation(s)
- Rohit Mahajan
- Department of Radiotherapy and Oncology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Budhi Singh Yadav
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh Chander Sharma
- Department of Radiotherapy and Oncology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
| | - Ankita Gupta
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikhar Kumar
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kaoutar C, Ahmedou AB, youssef O, Sami R, Abada R, Mohamed R, Mohamed M. Primary Non-Hodgkin Lymphoma of the temporal bone: A rare case report. Ann Med Surg (Lond) 2021; 64:102205. [PMID: 33815785 PMCID: PMC8010394 DOI: 10.1016/j.amsu.2021.102205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Primary lymphoma of the temporal bone is extremely rare, difficult to diagnose and to manage. It is essential that the clinician keeps in mind the possibility of this pathology as a differential diagnosis with the infections resistant to the usual treatment. CASE REPORT We report a rare case of a diffuse large B-cell lymphoma in a 70-year-old- woman, with history of diabetes. The pathological study was in favor of a Non-Hodgkin Lymphoma of the Temporal Bone. DISCUSSION Lymphomas defined as malignant monoclonal proliferation of lymphoid cells, are not uncommon in the head and neck region. Literature presents with few cases. CONCLUSION The aim of this article is to report a rare case of a diffuse large B-cell lymphoma with primary mastoid and external auditory canal infiltration without systemic involvement initially presented as a benign ear infection.
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Affiliation(s)
- Chaker Kaoutar
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Ahmed Brahim Ahmedou
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Oukessou youssef
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Rouadi Sami
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Redallah Abada
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Roubal Mohamed
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Mahtar Mohamed
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
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Tazi I, Benmoussa A, Boufarissi FZ, RajaaTissir, Lahlimi FZ. [Adult non-Hodgkin bone lymphomas]. Bull Cancer 2021; 108:424-434. [PMID: 33722379 DOI: 10.1016/j.bulcan.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 10/21/2022]
Abstract
Two forms of bone lymphomas can be distinguished: the primary bone lymphoma (PBL) and the secondary bone lymphoma (SBL). PBL is a rare disease with a good prognosis. Clinical manifestations and imaging findings are usually non-specific. Patient can present with pain, swelling of affected bone or pathologic fracture. Positron emission tomography-CT scan is a sensitive imaging modality and very useful for staging, restaging, surveillance of recurrence, and monitoring of treatment response of lymphoma. The diagnosis of PBL is often difficult and made after biopsy examination. Most patients have diffuse large B-cell lymphoma. Patients have been treated with radiotherapy, chemotherapy or combination of both. Localized disease, low IPI (International Prognostic Index) and complete remission after initial treatment were associated with a better outcome. Management of late sequelae deserves particular attention. SBL is more common than PBL; this is a disseminated lymphoma with concomitant involvement of the skeleton. We review the clinical, imaging and pathologic features of bone lymphomas; and discuss therapeutic modalities as well as prognosis of these lymphomas in the era of immunochemotherapy.
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Affiliation(s)
- Illias Tazi
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc.
| | - Amine Benmoussa
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
| | - Fatima Zahra Boufarissi
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
| | - RajaaTissir
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
| | - Fatima Zahara Lahlimi
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
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Liu CX, Xu TQ, Xu L, Wang PP, Cao C, Gao GX, Zheng YH. Primary lymphoma of bone: a population-based study of 2558 patients. Ther Adv Hematol 2020; 11:2040620720958538. [PMID: 32994912 PMCID: PMC7502855 DOI: 10.1177/2040620720958538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Primary lymphoma of bone (PLB) is an extremely rare malignancy arising in the skeletal system. There is no consensus over the best definition of PLB. Most of the published articles are single-institutional retrospective studies with a limited sample size. The rarity of PLB and discrepancies on diagnostic criteria has resulted in a vague understanding of PLB. Methods We retrospectively analyzed the clinical characteristics and prognostic factors of 2558 PLB patients who were registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2016. Survival rates were calculated using the Kaplan–Meier method. The effects of various factors on survival outcomes were analyzed by using the log-rank test. Univariate and multivariate analyses were conducted by using the Cox proportional hazards model to determine independent prognostic factors. Results: The median follow-up time of all eligible patients was 58 months. There seemed no sex preponderance in PLB incidence. The most involved sites are axial skeletons. The most common histological subtype was diffuse large B-cell lymphoma. The 3-, 5-, 10-, and 20-year overall survival (OS) rates were 70.70%, 65.70%, 54.40% and 39.50%, respectively. PLB patients whose primary tumor sites were appendicular and craniofacial skeletons had a significant survival advantage [hazard ratio (HR) = 0.694, 95% confidence interval (CI) 0.552–0.872; HR = 0.729, 95% CI 0.597–0.889, respectively] over those with axial skeletons as primary tumor sites. Patients with Hodgkin lymphoma, non-Hodgkin lymphoma (NHL)–mature B-cell lymphoma, and NHL-precursor-cell lymphoblastic lymphoma also had a significant OS advantage (HR = 0.392, 95% CI 0.200–0.771; HR = 0.826, 95% CI 0.700–0.973; and HR = 0.453, 95% CI 0.223–0.923, respectively). Patients with Ann Arbor stage III–IV at diagnosis were at higher risk of death than those with stage I–II (HR = 1.348, 95% CI 1.107–1.641). Chemotherapy was an independent favorable prognostic factor (HR = 0.734, 95% CI 0.605–0.890). Conclusions: Primary anatomic site, histology type, higher Ann Arbor stage and chemotherapy were independent prognostic factors. Chemotherapy played a pivotal role in PLB treatment.
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Affiliation(s)
- Chen-Xin Liu
- Institute of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tian-Qi Xu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Li Xu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Pan-Pan Wang
- Institute of Pediatrics, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, China
| | - Chun Cao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guang-Xun Gao
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, 127 Chang'le West Road, Xi'an, Shaanxi 710032, PR China
| | - Yan-Hua Zheng
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, 127 Chang'le West Road, Xi'an, Shaanxi 710032, PR China
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Viotto CT, Simões NN, Borges ACDO, Torresan C. Primary pediatric Burkitt's lymphoma of both femurs-case report. Hematol Transfus Cell Ther 2020; 44:275-278. [PMID: 33039384 PMCID: PMC9123555 DOI: 10.1016/j.htct.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/21/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | - Clarissa Torresan
- Centro Universitário de Maringá (UNICESUMAR), Maringá, Paraná, Brazil
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10
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Abstract
We report a case of primary temporal bone diffuse B-cell non-Hodgkin lymphoma, which is a rare entity. A 71-year-old male with a history of dementia and hemicraniectomy presented due to 1 month of a pronounced left ulcerative mastoid lesion. Strikingly, there were no cranial nerve deficits which was unexpected due to the degree of the lesion. Initially, infectious mastoiditis was suspected based on physical examination alone. Due to the patient being a poor historian, it was difficult to determine whether this was an acute or chronic issue. Temporal bone squamous cell carcinoma, infectious mastoiditis, and actinomycosis were on the differential, but biopsies revealed non-Hodgkin lymphoma.
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Affiliation(s)
- Eytan Keidar
- Department of Otolaryngology, 21138McLaren Oakland Health System, Michigan State University, Pontiac, MI, USA
| | - Ian Bowers
- Department of Otolaryngology, 21138McLaren Oakland Health System, Michigan State University, Pontiac, MI, USA
| | - Eric Sargent
- Michigan Ear Institute, Farmington Hills, MI, USA
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Sharma A, Ahmed R, Agrawal N, Kapoor J, Sharma A, Khushoo V, Agrawal P, Bhurani D, Mirgh SP. Primary Bone Lymphoma: A 13 Year Retrospective Institutional Analysis in the Chemo-Immunotherapy Era. Indian J Hematol Blood Transfus 2020; 37:240-248. [PMID: 33867730 DOI: 10.1007/s12288-020-01327-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/03/2020] [Indexed: 01/15/2023] Open
Abstract
Primary Lymphoma of bone (PBL) is an uncommon extranodal tumor accounting for 1% of all malignant lymphomas. The incidence of PBL is so rare that many of its aspects remain unknown. We retrospectively analysed our data in order to know clinical characteristics and treatment outcome in Indian population in chemo-immunotherapy era. We identified 49 patients [2007-2019] (median age 52 years) of which, 35 (71.4%) were males. Nearly one-third patients (n = 18; 36.8%) were elderly (Age > 60). The most common histological subtype was DLBCL. Local pain /swelling (n = 23; 47%) and B symptoms (n = 20; 44.4%) was the most common presentation. Spine was the most frequently involved site (n = 25; 51%) followed by pelvis (n = 17; 34.7%). One third patients had poor ECOG-PS ≥ 2, (n = 16; 32.6). More than 50% of the population presented with IPI score ≥ 2 (n = 25; 55.5%). Majority of the patients presented with Ann-Arbor stage IV disease (n = 31; 63.2%). (n = 32; 71.1%) cases received chemotherapy alone and (n = 13; 28.9%) patients were treated in combination with local radiotherapy. R-CHOP was the most common treatment regimen given to patients (n = 43; 95.5%). Overall, three-fourth patients (n = 36; 80%) achieved a complete response. At a median follow-up of 45 ± 2 (range 3-144) months, 4-year OS (Overall Survival) and PFS (Progression free survival) was 83.1% and 74.5%, respectively, using Kaplan-Meier survival curves. Prognostic factors for OS on multivariate analysis were ECOG-PS 0-1 [p = 0.05], age < 60 [p = 0.03] and achievement of CR [p = 0.001]. PBL in India is usually of DLBCL subtype, with spine as the most common site. It has an excellent prognosis in the R-CHOP era. Chemo-immunotherapy with 6 R-CHOP followed by addition of Radiotherapy if partial response appears to provide good outcomes. However, the exact role of radiation still needs to be confirmed.
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Affiliation(s)
- Archana Sharma
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Rayaz Ahmed
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narendra Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Jyotsna Kapoor
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Anurag Sharma
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vishvdeep Khushoo
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Pragya Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Sumeet P Mirgh
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
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12
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Primary Bone Lymphoma: A Case Series and Review of Literature. Case Rep Hematol 2020; 2020:4254803. [PMID: 32328322 PMCID: PMC7171650 DOI: 10.1155/2020/4254803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/26/2020] [Indexed: 01/19/2023] Open
Abstract
Primary bone lymphoma (PBL) is a subtype of lymphoma that exclusively affects skeletal tissue. Despite the relatively common involvement of skeletal structures as a manifestation of non-Hodgkin's lymphoma (NHL), primary and exclusive involvement of the skeletal system is rare. The prevalence of PBL is estimated to be 3–7% amongst primary bone tumors and less than 2% amongst all lymphomas in adults. However, the definition of primary bone lymphoma has been inconsistent over time. Within our institution, we identified four cases of primary bone lymphoma based on diagnostic criteria formed from the general consensus of multiple organizations, including the World Health Organization (WHO) and International Extranodal Lymphoma Study Group (IELSG). Here, we discuss the distinct characteristics amongst these cases in addition to performing a systematic review of current literature regarding this lymphoproliferative entity.
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13
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Surgical Outcomes and Prognostic Factors in Patients With Diffuse Large B-cell Lymphoma-associated Metastatic Spinal Cord Compression. Spine (Phila Pa 1976) 2016; 41:E943-E948. [PMID: 26890958 DOI: 10.1097/brs.0000000000001511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to discuss the factors that may affect surgical outcomes of patient with diffuse large B-cell lymphoma (DLBCL)-associated metastatic spinal cord compression (MSCC). SUMMARY OF BACKGROUND DATA DLBCL in the spine is rare and minimal information has been published in the literature regarding this subject. Although DLBCL is highly sensitive to both chemotherapy and radiotherapy, surgical decompression is recommended in the treatment of DLBCL-associated MSCC. However, the prognostic factors affecting surgical outcomes of patients with DLBCL-associated MSCC remain unknown. METHODS We conducted a retrospective study to investigate the impact of surgical decompression on recovery from neurological deficit caused by DLBCL-associated MSCC. Univariate and multivariate analyses were performed to identify prognostic factors for overall survival of spinal DLBCL. The survival rate was estimated by the Kaplan-Meier method, and differences were analyzed by the log-rank test. Factors with P values of 0.1 or less were subjected to multivariate analysis for survival rate by multivariate Cox proportional hazards analysis. RESULTS A total of 37 patients with spinal DLBCL from 2003 to 2014 were included in the study. International Prognostic Index (IPI) (0-1/2-5), duration of preoperative symptoms (≤2m/>2m), and lactate dehydrogenase (normal/abnormal) were suggested as the potential prognostic factors through univariate analysis. However, as they were submitted to the multivariate Cox regression model, only IPI and duration of preoperative symptoms were found as independent prognostic factors. CONCLUSION Surgical decompression improves recovery from neurological deficit. Patient IPI score plays an important role in decision making for surgical intervention, as it affects the length of survival and functional outcome. Patients with duration of preoperative symptoms no more than 2 months confer a very poor prognosis. LEVEL OF EVIDENCE 4.
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14
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Pilorge S, Harel S, Ribrag V, Larousserie F, Willems L, Franchi P, Legoff M, Biau D, Anract P, Roux C, Blanc-Autran E, Delarue R, Gisselbrecht C, Ketterer N, Recher C, Bonnet C, Peyrade F, Haioun C, Tilly H, Salles G, Brice P, Bouscary D, Deau B, Tamburini J. Primary bone diffuse large B-cell lymphoma: a retrospective evaluation on 76 cases from French institutional and LYSA studies. Leuk Lymphoma 2016; 57:2820-2826. [PMID: 27118302 DOI: 10.1080/10428194.2016.1177180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare DLBCL location variant. We treated 76 PB-DLBCL patients by immuno-chemotherapy, resulting in an 84% sustained complete remission rate and a 78.9% survival over a 4.7-year median follow-up period. Ann Arbor stage IV and high age-adjusted international prognostic index were predictive of adverse outcome in univariate analysis. In multivariate analysis using a Cox model, only aa-IPI predicted long-term survival. While based on a limited number of cases, we suggested that radiotherapy may be useful as a consolidation modality in PB-DLBCL. We also suggested that positron emission tomography/CT scan should be interpreted with caution due to a persistent [18F]fluorodeoxyglucose [18FDG] uptake of bone lesions even after remission in some in PB-DLBCL patients. Our study based on a homogeneous cohort of PB-DLBCL patients confirmed the favorable outcome of this DLBCL variant and support the implementation of prospective clinical trials in this disease.
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Affiliation(s)
- Sylvain Pilorge
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Stephanie Harel
- c Lymphoid Malignancies Unit , Saint Louis Hospital , Paris , France
| | | | - Frédérique Larousserie
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,e Pathology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France
| | - Lise Willems
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Patricia Franchi
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Marielle Legoff
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - David Biau
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,f Orthopedic Surgery Department , Cochin Hospital, AP-HP , Paris, France
| | - Philippe Anract
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,f Orthopedic Surgery Department , Cochin Hospital, AP-HP , Paris, France
| | - Christian Roux
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,g Rhumatology Department , Cochin Hospital, AP-HP , Paris, France
| | - Estelle Blanc-Autran
- h Nuclear Medicine Department , Centre Medico-Chirurgical Marie-Lannelongue , Le Plessis-Robinson , France
| | | | | | | | - Christian Recher
- l Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Christophe Bonnet
- m Département de Médecine, Service d'Hématologie Clinique , CHU Liège, Campus Universitaire du Sart-Tilman , Belgique
| | - Frederic Peyrade
- n Department of Oncology , Antoine-Lacassagne Center , Nice , France
| | - Corinne Haioun
- o Department of Hematology , Henri Mondor University Hospital , Créteil , France
| | - Hervé Tilly
- p Centre Henri-Becquerel , Université de Rouen , Rouen , France
| | - Gilles Salles
- q Centre Hospitalier Lyon Sud , Service d'Hématologie, Hospices Civils de Lyon , Lyon , France
| | - Pauline Brice
- c Lymphoid Malignancies Unit , Saint Louis Hospital , Paris , France
| | - Didier Bouscary
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Bénédicte Deau
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Jerome Tamburini
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
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15
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Primary lymphoma of bone presenting as spindle cell neoplasm of the vertebral body: a case report and review of the literature. Case Rep Hematol 2015; 2015:518307. [PMID: 25984371 PMCID: PMC4423010 DOI: 10.1155/2015/518307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 04/05/2015] [Indexed: 11/18/2022] Open
Abstract
Spindle cell variant of lymphoma is a very rare but known disease entity that can mimic a sarcoma. Diagnosis can be even more challenging if the only site of the disease is in the bone. We report a case of primary lymphoma of bone with spindle cell morphology which was successfully treated with a combination of surgery, chemotherapy, and radiotherapy.
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16
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Tong MY, Zhang X, Yu Z, Sun XH, Li S, Zhang Y. Primary sternum diffuse large B-cell lymphoma: A case report and review of the literature. Oncol Lett 2015; 9:2623-2628. [PMID: 26137117 DOI: 10.3892/ol.2015.3122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 02/25/2015] [Indexed: 01/30/2023] Open
Abstract
Primary bone lymphoma (PBL) is a rare disease, accounting for >1% of all cases of malignant lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most common histological type of PBL. The present study reported the case of a 68-year-old male with primary bone DLBCL, originally occurred in the sternum, which is a rare form of presentation. Computed tomography (CT), magnetic resonance imaging and bone emission CT were performed, followed by immunohistochemical analysis of a biopsy specimen, and the results were used to establish the diagnosis. At the time of diagnosis, no osseous involvement was observed. The clinical, radiological and histological features of PBL can mimic other medical conditions, thereby making the diagnosis difficult, and frequently leading to delays in treatment. The present study investigated the clinical features, management and prognosis of PBL, and reviewed previous relevant cases.
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Affiliation(s)
- Meng-Ying Tong
- Graduate Institute of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Xian Zhang
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Zhe Yu
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Xiu-Hua Sun
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Shuang Li
- Graduate Institute of Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Yang Zhang
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
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17
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Messina C, Christie D, Zucca E, Gospodarowicz M, Ferreri AJM. Primary and secondary bone lymphomas. Cancer Treat Rev 2015; 41:235-46. [PMID: 25698636 DOI: 10.1016/j.ctrv.2015.02.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 12/24/2022]
Abstract
Recent studies have contributed to the enhancement of clinical and molecular knowledge on bone lymphomas, a group of rare malignancies with particular characteristics. Nevertheless, several questions remain unanswered and the level of evidence supporting some diagnostic and therapeutic decisions remains low. Currently, three different forms of bone lymphomas can be distinguished: the primary bone lymphoma, consisting of a single bone lesion with or without regional lymphadenopathies; the polyostotic lymphoma, consisting of multifocal disease exclusively involving the skeleton; and the disseminated lymphoma with secondary infiltration of the skeleton. The first two forms exhibit a good prognosis, requiring treatments similar to those commonly used for nodal lymphomas of the same category, but several issues regarding the role of surgery and local control of the disease, the sequence of treatment, radiation volumes and doses, management of pathological fractures and prevention of late sequelae deserve particular attention. Due to its rarity, prospective trials exclusively focused on bone lymphomas appear unrealistic, thus, critical revision of our own experience and analyses of large cumulative series as well as molecular studies on archival cases remain valid alternatives to improve our knowledge on this obscure lymphoproliferative malignancy. The present review is based on the analysis of the largest available database of bone lymphomas established under the sponsorship of the International Extranodal Lymphoma Study Group (IELSG) as well as on the critical revision of related literature. We provide recommendations for diagnosis, staging, treatment, and response assessment of these patients in everyday practice as well as for the management of special conditions like pathological fractures, indolent forms and central nervous system prophylaxis.
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Affiliation(s)
- Carlo Messina
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy
| | - David Christie
- Genesiscare and Bond University, Inland Dr., Tugun, QLD, Australia
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mary Gospodarowicz
- Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, ON, Canada
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Haematology, San Raffaele Scientific Institute, Milan, Italy.
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18
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Clinical characteristics and prognostic factors of bone lymphomas: focus on the clinical significance of multifocal bone involvement by primary bone large B-cell lymphomas. BMC Cancer 2014; 14:900. [PMID: 25465716 PMCID: PMC4265495 DOI: 10.1186/1471-2407-14-900] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 11/27/2014] [Indexed: 12/25/2022] Open
Abstract
Background Malignant bone lymphoma can be classified as primary (PBL) or secondary (SBL) bone lymphoma. However, the clinico-pathological characteristics and prognostic factors of PBL versus SBL have not yet been well defined. Whether lymphoma with multifocal bone involvement should be considered as stage IV PBL or SBL still remain controversial throughout the literature. Methods In this study, we retrospectively reviewed 127 patients with bone lymphoma diagnosed from1998 to 2013 at the Moffitt Cancer Center. Patients were classified as PBL (81 cases) and SBL (46 cases) using the 2013 WHO Classification of Bone/Soft Tissue Tumors and PBL patients were further subdivided into: 1) PBL with unifocal bone disease (uPBL, 46 cases), 2) PBL with multifocal bone involvement (mPBL, 35 cases). Patient characteristics, survival, and prognostic factors were analyzed. Results Diffuse large B-cell lymphoma (DLBCL) was the most common histological subtype in all three groups (37/46 of uPBL, 23/35 of mPBL, 23/46 of SBL). B symptoms, lymph node involvement, and bone marrow involvement were found to be more common in mPB-DLBCL and SB-DLBCL groups than in the uPB-DLBCL group. Femur was found to be the most common affected site in uPB-DLBCL patients, while spine was most commonly involved in the other two groups. Survival analysis indicated that uPBL-DLBCL patients had a significantly better progression-free survival (PFS) and overall survival (OS) than those in the other two groups (P < 0.05). We also found by univariate analysis that multifocality, and stage IV were significantly poor prognostic factors for both PFS and OS in PBL patients. Using multivariate analysis, multifocality remained an independent prognostic factor for both PFS and OS (P = 0.0117, RR: 3.789, 95% CI: 1.275-11.256). Conclusion Overall, our results suggest that mPBL is more similar to SBL in characteristics and survival rather than uPBL, and thus should be better classified and treated as SBL. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-900) contains supplementary material, which is available to authorized users.
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19
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Mondello P, Mian M, Arrigo C, Pitini V. Primary diffuse large B-cell lymphoma of the bone: bendamustine and rituximab are able to overcome resistant disease. SPRINGERPLUS 2014; 3:342. [PMID: 25045615 PMCID: PMC4101125 DOI: 10.1186/2193-1801-3-342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/01/2014] [Indexed: 11/10/2022]
Abstract
Primary bone lymphoma (PBL) is a rare disease for which specific therapeutic guidelines have not yet been established. Due to common appearance in the elderly and recurring relapses, new treatments are required. We report the case of multiple relapsed aggressive PBL effectively treated using Bendamustine and Rituximab. A 78-year-old male patient presented with a painful mass in the left arm. Computed tomography (CT) showed a pathological tissue in the humerus diaphysis infiltrating the muscle, confirmed by positron emission tomography (PET) scan. Indeed, PET excluded pathological local lymph node involvement. Biopsy of the humerus revealed the presence of diffuse large B cell lymphoma. Recommended treatments for PBL were used, but relapses after an initial complete response occurred. Following the positive experience of Vacirca et al. the patient underwent Bendamustin 90 mg/mq gg1-2 q28 plus Rituximab 375 mg/mq q28 (BR). Herein we report the first experience of BR combination in PBL and it proved to be an efficacious and safe salvage therapy in relapsed/refractory PBL.
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Affiliation(s)
- Patrizia Mondello
- Department of Medical Oncology, University of Messina, Messina, Italy
| | - Michael Mian
- Department of Hematology & CTMO, Hospital of Bolzano, Bolzano, Italy ; Department of Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carmela Arrigo
- Department of Medical Oncology, University of Messina, Messina, Italy
| | - Vincenzo Pitini
- Department of Medical Oncology, University of Messina, Messina, Italy
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20
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Bruno Ventre M, Ferreri AJM, Gospodarowicz M, Govi S, Messina C, Porter D, Radford J, Heo DS, Park Y, Martinelli G, Taylor E, Lucraft H, Hong A, Scarfò L, Zucca E, Christie D. Clinical features, management, and prognosis of an international series of 161 patients with limited-stage diffuse large B-cell lymphoma of the bone (the IELSG-14 study). Oncologist 2014; 19:291-8. [PMID: 24567283 DOI: 10.1634/theoncologist.2013-0249] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The clinical features, management, and prognosis of stage I-II diffuse large B-cell lymphoma of the bone (PB-DLBCL) included in an international database of 499 lymphoma patients with skeletal involvement were reviewed. METHODS HIV-negative patients (n = 161) with diffuse large B-cell lymphoma of the bone (PB-DLBCL) after complete staging workup were considered. The primary objective of this study was to identify the most effective treatment modality; the secondary objectives were to define the contribution of irradiation fields and doses and the pattern of relapse. RESULTS Median age was 55 years (range, 18-99 years), with a male/female ratio of 1:2; 141 (87%) patients had stage I, 14 (9%) had B symptoms, 37 (23%) had bulky lesion, 54 (33%) showed elevated lactate dehydrogenase serum levels, and 25 (15%) had fracture. Thirteen (8%) patients received chemotherapy alone, 23 (14%) received radiotherapy alone, and 125 (78%) received both treatments. The response to the first-line treatment was complete in 131 of 152 assessed patients (complete response rate, 86%; 95% confidence interval [CI], 81%-91%) and partial in 7, with an overall response rate of 91% (95% CI, 87%-95%). At a median follow-up of 54 months (range, 3-218), 107 (67%) patients remained relapse-free, with a 5-year progression-free survival of 68% (SE: 4). Four (2.5%) patients had meningeal relapse; 119 patients were alive (113 disease-free), with a 5-year overall survival of 75% (SE: 4). Patients managed with primary chemotherapy, whether followed by radiotherapy or not, had a significantly better outcome than patients treated with primary radiotherapy, whether followed by chemotherapy or not. The addition of consolidative radiotherapy after primary chemotherapy was not associated with improved outcome; doses >36 Gy and the irradiation of the whole affected bone were not associated with better outcome. CONCLUSION Patients with PB-DLBCL exhibit a favorable prognosis when treated with primary anthracycline-based chemotherapy whether followed by radiotherapy or not. In patients treated with chemoradiotherapy, the use of larger radiation fields and doses is not associated with better outcome. Central nervous system dissemination is a rare event in PB-DLBCL patients.
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Affiliation(s)
- Marta Bruno Ventre
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy; Department of Radiation Oncology, Princess Margaret Hospital, Ontario Cancer Institute, Toronto, Canada; Auckland Hospital, Auckland, New Zealand; Christie Hospital, Manchester, United Kingdom; Seoul National University Hospital, Seoul, Korea; Korea Cancer Center Hospital, Seoul, Korea; Division of Hematology, European Institute of Oncology, Milan, Italy, Wesley Research Institute, Brisbane, Australia; Northern Centre for Cancer, New Castle, United Kingdom; Royal Prince Alfred Hospital, Sydney, Australia; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Premion and Bond University, Tugun, Australia
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21
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Lymphome osseux primitif localisé : à propos de quatre cas. Cancer Radiother 2014; 18:23-7. [DOI: 10.1016/j.canrad.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 11/22/2022]
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22
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Woo YL, Tan MH. Primary Lymphoma of the Bone — The Bone Lesion Difficult to Place Your Finger on. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary lymphoma of the bone is a rare cause of bone tumour. It is often overlooked and mis-diagnosed due to its rarity, uncommon presentation and indistinctive radiographic features. We report a patient who had a slow progressing primary bone lymphoma whose final diagnosis was only made after an open biopsy.
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Affiliation(s)
- Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Mann Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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23
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Traitement des lymphomes osseux primitifs. Cancer Radiother 2013; 17:774-7; quiz 785, 788. [DOI: 10.1016/j.canrad.2013.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/22/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022]
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Held G, Zeynalova S, Murawski N, Ziepert M, Kempf B, Viardot A, Dreyling M, Hallek M, Witzens-Harig M, Fleckenstein J, Rübe C, Zwick C, Glass B, Schmitz N, Pfreundschuh M. Impact of Rituximab and Radiotherapy on Outcome of Patients With Aggressive B-Cell Lymphoma and Skeletal Involvement. J Clin Oncol 2013; 31:4115-22. [DOI: 10.1200/jco.2012.48.0467] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To study clinical presentation, outcome, and the role of radiotherapy in patients with aggressive B-cell lymphoma and skeletal involvement treated with and without rituximab. Patients and Methods Outcome of patients with skeletal involvement was analyzed in a retrospective study of nine consecutive prospective trials of the German High-Grade Non-Hodgkin lymphoma Study Group. Results Of 3,840 patients, 292 (7.6%) had skeletal involvement. In the MabThera International Trial (MInT) for young good-prognosis patients and the Rituximab With CHOP Over 60 Years (RICOVER-60) study for elderly patients, the randomized addition of rituximab improved event-free survival (EFS; hazard ratio for MInT [HRMInT] = 0.4, P > 001; hazard ratio for RICOVER-60 [HRRICOVER-60] = 0.6, P > .001) and overall survival (OS; HRMInT = 0.4, P < .001; HRRICOVER-60 = 0.7, P = .002) in patients without skeletal involvement, but failed to improve the outcome of patients with skeletal involvement (EFS: HRMInT = 1.4, P = .444; HRRICOVER-60 = 0.8, P = .449; OS: HRMInT = 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935). Skeletal involvement was associated with a worse outcome after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab (HREFS = 1.5, P = .048; HROS = 1.1; P = .828), but not after CHOP without rituximab (HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In contrast to rituximab, additive radiotherapy to sites of skeletal involvement was associated with a decreased risk (HREFS = 0.3, P = .001; HROS = 0.5; P = .111). Conclusion Rituximab failed to improve the outcome of patients with diffuse large B-cell lymphoma with skeletal involvement, although our data suggest a beneficial effect of radiotherapy to sites of skeletal involvement. Whether radiotherapy to sites of skeletal involvement can be spared in cases with a negative positron emission tomography after immunochemotherapy should be addressed in appropriately designed prospective trials.
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Affiliation(s)
- Gerhard Held
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Samira Zeynalova
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Niels Murawski
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Marita Ziepert
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Barbara Kempf
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Andreas Viardot
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Martin Dreyling
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Michael Hallek
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Mathias Witzens-Harig
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Jochen Fleckenstein
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Christian Rübe
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Carsten Zwick
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Bertram Glass
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Norbert Schmitz
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
| | - Michael Pfreundschuh
- Gerhard Held, Niels Murawski, Jochen Fleckenstein, Christian Rübe, and Michael Pfreundschuh, Saarland University Medical School; Bertram Glass and Norbert Schmitz, Asklepios-Klinik St. Georg, Hamburg; Samira Zeynalova and Marita Ziepert, Leipzig University, Leipzig; Barbara Kempf, Klinikum Landshut, Landshut; Andreas Viardot, Universitätsklinikum Ulm, Ulm; Martin Dreyling, Ludwig-Maximilian University, Munich; Michael Hallek, Cologne University, Cologne; and Mathias Witzens-Harig, Heidelberg University,
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25
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Matikas A, Briasoulis A, Tzannou I, Oikonomopoulou D, Bakiri M, Karmiris T, Harhalakis N. Primary bone lymphoma: a retrospective analysis of 22 patients treated in a single tertiary center. Acta Haematol 2013; 130:291-6. [PMID: 24008727 DOI: 10.1159/000351051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/06/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary bone lymphoma is a rare disease, representing less than 5% of all extra-nodal non-Hodgkin lymphomas. MATERIALS AND METHODS We retrospectively searched the database of the lymphoma unit, Hematology/Lymphoma Department, Athens General Hospital 'Evangelismos' for primary bone lymphoma patients. Demographic and clinicopathologic data were collected and overall survival was analyzed. A log-rank test was used in a univariate analysis to identify factors affecting overall survival. RESULTS We identified 24 and analyzed data from 22 patients. 12 were male (54.5%) and 10 female (45.4%) and their median age was 55 years (range: 19-83). Most patients had localized disease at the time of diagnosis (n = 19, 86.3%), the most common site was the spine (n = 11, 50%) and the most common histology was diffuse large B-cell lymphoma. 21 patients received chemotherapy as initial therapy and 16 received combined chemoradiation. 81.8% of the patients (n = 18) achieved complete remission. 5-year survival rate was 86.3% and overall survival was found to be affected by the patients' initial response to treatment. CONCLUSIONS Primary bone lymphoma is usually associated with a good prognosis. Prospective studies are needed in order to clarify the effect of immunochemotherapy in overall survival.
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Affiliation(s)
- Alexios Matikas
- Lymphoma, Hematology and Bone Marrow Transplant Department, Evangelismos General Hospital, Athens, Greece
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26
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Mohamed M, Brain T, Sharma S. Multifocal primary bone lymphoma: durable complete remission after R-CHOP chemotherapy. BMJ Case Rep 2013; 2013:bcr-2013-009809. [PMID: 23704456 DOI: 10.1136/bcr-2013-009809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary bone lymphoma (PBL) is a type of non-Hodgkin's lymphoma predominantly affecting the skeletal system. PBL is an extremely rare cancer in adults affecting mainly the axial skeleton. The extent of bone involvement in these patients is variable. Most of the cases reported had single or a few skeletal lesions. We report a patient who had extensive multifocal lymphoma involving the axial skeleton and a very good and durable response to R-CHOP chemotherapy.
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Affiliation(s)
- Muhajir Mohamed
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia.
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27
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Blume P, Charlot-Hicks F, Mohammed S. Case report and review of primary bone diffuse large B-cell lymphoma involving the calcaneus. J Foot Ankle Surg 2013; 52:666-72. [PMID: 23628193 DOI: 10.1053/j.jfas.2013.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Indexed: 02/03/2023]
Abstract
Primary bone lymphoma from diffuse large B-cell lymphoma is a very rare condition, especially in the foot. In the present case report, a 23-year-old female patient presented with long-term pain along the lateral aspect of her right calcaneus. Ancillary magnetic resonance imaging revealed a radiolucent bone tumor in the calcaneus. Computed tomography-guided biopsy of the bone was completed and revealed chronic inflammation with hematopoietic elements. The patient continued to have pain and limitation in her daily activities after the biopsy. The patient underwent surgical excision and curettage by the senior author. Pathologic examination revealed that the lesion was consistent with diffuse, large, B-cell lymphoma, stage IAE. The lesion appeared to have been completely excised at surgery, and the patient underwent 3 cycles of chemotherapy and 15 radiotherapy sessions to the calcaneus. At the last follow-up visit, the patient had been disease free for 5 years. To our knowledge, this is the first case report of primary bone, diffuse, large B-cell lymphoma of the calcaneus to be treated with a combination of surgical excision, chemotherapy, and radiotherapy.
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Affiliation(s)
- Peter Blume
- Section of Podiatric Surgery, Department of Orthopedics, Yale University School of Medicine, New Haven, CT 06511, USA.
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28
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Kim SY, Shin DY, Lee SS, Suh C, Kwak JY, Kim HG, Lee JH, Lee SI, Lee YR, Kang SH, Mun SK, Lee MJ, Lee HR, Yang SH, Kang HJ. Clinical characteristics and outcomes of primary bone lymphoma in Korea. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:213-8. [PMID: 23071477 PMCID: PMC3464339 DOI: 10.5045/kjh.2012.47.3.213] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 08/08/2012] [Accepted: 09/10/2012] [Indexed: 11/17/2022]
Abstract
Background This study evaluates the effectiveness of immunochemotherapy and radiation therapy in the treatment of patients with primary bone lymphoma (PBL). Methods We retrospectively reviewed the medical records of 33 patients with PBL who were treated at 6 medical centers in Korea from 1992 to 2010. Clinicopathological features and treatment outcomes were analyzed. Results The median age of the patients participating in our study was 40 years. The most common sites of involvement were the pelvis (12.36%) and femur (11.33%). CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like regimens were administered to 20 patients (61%), and R-CHOP (rituximab plus CHOP) was administered to the remaining 13 patients (39%). The overall response rate was 89% (complete response, 76%; partial response, 12%). The overall survival (OS) of patients with solitary bone lesions was longer than that of patients with multiple bone lesions (median OS: not reached vs. 166 months, respectively; P=0.089). Addition of rituximab to CHOP did not significantly affect either OS or progression-free survival (P=0.53 and P=0.23, respectively). Combining radiation therapy with chemotherapy also did not improve the OS or progression-free survival of patients with solitary bone lesions. Conclusion Conventional cytotoxic chemotherapy remains an effective treatment option for patients with PBL. Additional benefits of supplementing chemotherapy with either rituximab or radiation therapy were not observed in this study. Further investigation is needed to characterize the role of immunochemotherapy in treating patients with PBL.
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Affiliation(s)
- So Yeon Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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29
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Abstract
Primary bone lymphoma is a distinct clinical entity that accounts for 5% of extra-nodal lymphoma. Most patients have diffuse large B-cell lymphoma and present with bone pain, a mass or both. The involvement could be in a single focus or disseminated. There are no prospective clinical studies in this disease. Patients have been treated with radiotherapy, chemotherapy or a combination. There is a trend towards improved outcome with combined modality treatment and further improvement with the addition of rituximab. Assessment of response may be difficult with current imaging techniques. The prognosis of primary bone lymphoma is generally good. Here, the current evidence for the optimal treatment of primary bone lymphoma is reviewed and questions for future investigation are addressed.
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Affiliation(s)
- N G Mikhaeel
- Guy's & St. Thomas' NHS Foundation Trust, London, UK.
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30
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Abstract
Diagnosing small round cell tumors (SCRTs) can be a difficult task for pathologists due to overlapping clinicopathologic features. This review highlights the clinical, radiographic, histologic, immunohistochemical, and genetic features of the most common SRCTs involving bone with an emphasis on differential diagnosis. SRCTs are a heterogeneous group of neoplasms characterized by poorly differentiated cells with small, blue, round nuclei and scant cytoplasm. They can occur as primary tumors in bone or soft tissue.
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Affiliation(s)
- Justin L Seningen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Carrie Y Inwards
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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31
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Cai L, Stauder MC, Zhang YJ, Poortmans P, Li YX, Constantinou N, Thariat J, Kadish SP, Nguyen TD, Kirova YM, Ghadjar P, Weber DC, Bertran VT, Ozsahin M, Mirimanoff RO. Early-stage primary bone lymphoma: a retrospective, multicenter Rare Cancer Network (RCN) Study. Int J Radiat Oncol Biol Phys 2011; 83:284-91. [PMID: 22079728 DOI: 10.1016/j.ijrobp.2011.06.1976] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 06/08/2011] [Accepted: 06/15/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE Primary bone lymphoma (PBL) represents less than 1% of all malignant lymphomas. In this study, we assessed the disease profile, outcome, and prognostic factors in patients with Stages I and II PBL. PATIENTS AND METHODS Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Eighty-seven patients underwent chemoradiotherapy (CXRT) without (78) or with (9) surgery, 15 radiotherapy (RT) without (13) or with (2) surgery, and 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range, 4-60). The median number of CXT cycles was six (range, 2-8). Median follow-up was 41 months (range, 6-242). RESULTS The overall response rate at the end of treatment was 91% (complete response [CR] 74%, partial response [PR] 17%). Local recurrence or progression was observed in 12 (10%) patients and systemic recurrence in 17 (15%). The 5-year overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78%, and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS and LSS were International Prognostic Index (IPI) score ≤1 (p = 0.009), high-grade histology (p = 0.04), CXRT (p = 0.05), CXT (p = 0.0004), CR (p < 0.0001), and RT dose >40 Gy (p = 0.005). For LC, only CR and Stage I were favorable factors. In multivariate analysis, IPI score, RT dose, CR, and CXT were independently influencing the outcome (OS and LSS). CR was the only predicting factor for LC. CONCLUSION This large multicenter retrospective study confirms the good prognosis of early-stage PBL treated with combined CXRT. An adequate dose of RT and complete CXT regime were associated with better outcome.
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Affiliation(s)
- Ling Cai
- Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland
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32
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Waimann CA, Lu H, Suarez Almazor ME. Rheumatic manifestations of primary and metastatic bone tumors and paraneoplastic bone disease. Rheum Dis Clin North Am 2011; 37:527-49. [PMID: 22075196 DOI: 10.1016/j.rdc.2011.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bone tumors can show a wide range of nonspecific rheumatic manifestations. The presence of unexplained or atypical chronic bone pain, an enlarging bone mass, neurovascular compression syndromes, or pathologic fractures should alert us to the possibility of a bone tumor causing these symptoms. These patients must undergo a complete physical examination; adequate imaging; and, if needed, a biopsy to confirm their diagnosis and offer them an opportune treatment. In addition, bone tumors and other malignancies can present remote clinical manifestations and unusual laboratory findings (eg, HOA, hypophosphatemia, hyperphosphaturia, and hypercalcemia) that may be the first and early manifestation of an occult cancer. These findings should motivate a cancer screening according to age, sex, and personal history. Cancer therapies also have a big impact on bone health, increasing the risk of osteoporosis, osteomalacia, and/or osteonecrosis. Rheumatologists should be aware of possible long-term adverse events of cancer treatment to avoid future complications.
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Affiliation(s)
- Christian A Waimann
- Section of Rheumatology, Department of General Internal Medicine, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1465, Houston, TX 77030, USA.
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33
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Miles EF, Balsamo L, Turton DB, Graf W. Recurrent PET FDG Uptake after Sequential Chemotherapy and Radiation Therapy for DLBCL of the Tibia: A Case Report and Review of the Literature. Case Rep Oncol Med 2011; 2011:163472. [PMID: 22606440 PMCID: PMC3350025 DOI: 10.1155/2011/163472] [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] [Received: 07/20/2011] [Accepted: 08/18/2011] [Indexed: 11/21/2022] Open
Abstract
The aim of this paper is to report on the challenges associated with identifying disease recurrence following combined modality therapy (CMT) for primary lymphoma of the tibia in which an intramedullary nail has been placed. A patient with primary bone lymphoma (PBL) was treated with CMT (chemotherapy and radiation therapy). After a complete response, he has been followed for eighteen months by physical exam and radiographic imaging. Despite persistent increased tracer accumulation at the original site, he has no proven recurrence. Literature review showed a small number of retrospective, single institution reviews detailing clinical experience and expected outcome in patients treated with PBL limited to one bony site of disease. PBL presents a treatment challenge, particularly when a weight-bearing long bone is diffusely involved and followup is complicated after placement of stabilizing hardware. Close coordination of the oncology team and diagnostic radiology is required to ensure optimal outcome.
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Affiliation(s)
- Edward F. Miles
- Division of Radiation Oncology, Department of Radiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - Luke Balsamo
- Division of Orthopedics, Department of Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - David B. Turton
- Division of Nuclear Medicine, Department of Radiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
| | - William Graf
- Division of Interventional Radiology, Department of Radiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA
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34
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Jiang ZY, Saadia-Redleaf MI. Primary lymphoma of the temporal bone presenting as XIIth cranial nerve weakness. EAR, NOSE & THROAT JOURNAL 2011; 90:125-7. [PMID: 21412743 DOI: 10.1177/014556131109000311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary lymphoma of the temporal bone is an extremely rare finding in clinical practice. Although it is treated as a type of non-Hodgkin lymphoma, the absence of systemic signs and symptoms makes detection dependent on the tumor's local mass effect. In this article, we report a case of temporal bone lymphoma that caused XIIth nerve palsy. We also discuss the clinical manifestations of temporal bone lymphoma and the importance of imaging the head and neck when any idiopathic cranial nerve palsy develops.
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Affiliation(s)
- Zi Yang Jiang
- Department of Otolaryngology, School of Medicine, University of Illinois at Chicago, 1885 W. Taylor St., Chicago, IL 60612, USA
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35
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Pellegrini C, Gandolfi L, Quirini F, Ruggieri P, Stefoni V, Derenzini E, Broccoli A, Argnani L, Pileri S, Mercuri M, Baccarani M, Zinzani PL. Primary Bone Lymphoma: Evaluation of Chemoimmunotherapy as Front-line Treatment in 21 Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:321-5. [PMID: 21816370 DOI: 10.1016/j.clml.2011.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 02/04/2011] [Accepted: 03/22/2011] [Indexed: 11/29/2022]
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Neoplasms/mortality
- Bone Neoplasms/therapy
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Immunologic Factors/administration & dosage
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Male
- Middle Aged
- Radiotherapy, Adjuvant/methods
- Remission Induction
- Retrospective Studies
- Rituximab
- Survival Rate
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Affiliation(s)
- Cinzia Pellegrini
- Institute of Hematology and Medical Oncology "L. e A. Seràgnoli," University of Bologna, Bologna, Italy
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36
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Senthilvel E, Subbiah S, Jain V, Seidman M. Primary diffuse large B-cell lymphoma of the skull mimicking osteomyelitis. EAR, NOSE & THROAT JOURNAL 2011; 90:E22-5. [PMID: 21229495 DOI: 10.1177/014556131109000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary lymphomas of the skull are extremely rare, as fewer than 20 cases have been reported in the literature. We describe the case of a 51-year-old woman with Huntington chorea who presented with forehead swelling. Imaging studies detected an enhancing mass in the skull with some destruction of the underlying bone. These features were suggestive of osteomyelitis. Surgical excision was performed, and the mass was found to be a primary diffuse large B-cell lymphoma. The patient was administered postoperative chemotherapy, and she was in complete remission at the 1-year follow-up.
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Affiliation(s)
- Egambaram Senthilvel
- Department of Family Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
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37
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García-García M, Remolina-Cabrera D, Antolí-Royo A, Martín-Enrique J. Linfoma no-Hodking óseo primario. Un análisis retrospectivo. Rev Clin Esp 2011; 211:435-6. [DOI: 10.1016/j.rce.2011.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 01/03/2011] [Accepted: 01/17/2011] [Indexed: 11/30/2022]
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38
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Azevedo CPC, Tavares PJAFF, Portela MIP, Santos AJLCP, Casanova JMPS. Primary bone lymphoma. BMC Proc 2010. [DOI: 10.1186/1753-6561-4-s2-p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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39
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Huang JJ, Xia Y, Zhu YJ, Lin TY, Li ZM, Jiang WQ, Xu RH, Huang HQ, Lv Y, Sun XF, Xia ZJ. Clinical characterization and prognostic factors of primary lymphoma of bone in case of Chinese patients. Med Oncol 2010; 28 Suppl 1:S476-82. [DOI: 10.1007/s12032-010-9666-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 08/18/2010] [Indexed: 11/29/2022]
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40
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Alencar A, Pitcher D, Byrne G, Lossos IS. Primary bone lymphoma--the University of Miami experience. Leuk Lymphoma 2010; 51:39-49. [PMID: 19860629 DOI: 10.3109/10428190903308007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Primary bone lymphoma (PBL) is a rare disease. There has been paucity of studies addressing its therapy and prognosis. We retrospectively examined PBL cases seen at the University of Miami from June 2000 to August 2007 to describe our single institution experience and review the literature. Fifty-three patients were identified with a median age of 52 (18-87) and a median follow-up of 40 months (0-106). The most common histologic type was diffuse large B-cell lymphoma (83%). Forty-one patients (77%) presented with localized disease and 48 were treated at our institution. Forty-six patients underwent chemotherapy (40 patients) and/or radiation (36 patients). Forty-four patients achieved a complete response and all patients were alive at last follow-up. The progression-free survival (PFS) was 83% at 4 years. No difference in PFS was observed between patients treated with chemotherapy or combined chemotherapy plus radiation. There was a trend toward improvement in PFS (p = 0.062) of patients with DLBCL treated with rituximab plus chemotherapy. Our single institutional experience demonstrates that the outcome of patients with PBL is excellent. Although the current data support the use of combined modality treatment for localized PBL, randomized controlled trials are needed especially now, when rituximab is routinely added to chemotherapy regimens.
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Affiliation(s)
- Alvaro Alencar
- Division of Hematology-Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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41
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Zhang X, Chang CK, Song LX, Xu L, Wu LY, Li X. Primary lymphoma of bone: a case report and review of the literature. Med Oncol 2010; 28:202-6. [DOI: 10.1007/s12032-009-9405-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 12/18/2009] [Indexed: 11/29/2022]
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42
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Yuste AL, Segura A, López-Tendero P, Gironés R, Montalar J, Gómez-Codina J. Primary Lymphoma of Bone: A Clinico-Pathological Review and Analysis of Prognostic Factors. Leuk Lymphoma 2009; 45:853-5. [PMID: 15160973 DOI: 10.1080/10428190310001615648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Gaitonde S, Patel R, Alagiozian-Angelova V, Kadkol S, Peace D. Primary low grade follicular lymphoma of cranial vault mimicking lipoma at presentation. Acta Oncol 2009; 47:326-9. [PMID: 17851874 DOI: 10.1080/02841860701558856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Catlett JP, Williams SA, O'Connor SC, Krishnan J, Malkovska V. Primary lymphoma of bone: an institutional experience. Leuk Lymphoma 2009; 49:2125-32. [PMID: 19021055 DOI: 10.1080/10428190802404030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Primary diffuse large B-cell lymphomas of the bone: prognostic relevance of protein expression and clinical factors. Hum Pathol 2008; 39:1323-30. [DOI: 10.1016/j.humpath.2008.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 01/07/2008] [Accepted: 01/08/2008] [Indexed: 11/21/2022]
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Hwang JE, Cho SH, Kim OK, Shim HJ, Lee SR, Ahn JS, Yang DH, Kim YK, Lee JJ, Kim HJ, Chung IJ. Newly developed multiple myeloma in a patient with primary T-cell lymphoma of bone. J Korean Med Sci 2008; 23:544-7. [PMID: 18583898 PMCID: PMC2526528 DOI: 10.3346/jkms.2008.23.3.544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary non-Hodgkin's lymphoma of bone (PLB) is rare, and generally presents as a single extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large B-cell lymphoma, and T-cell lymphoma is rare. By contrast, multiple myeloma is a disease defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. We report a case of multiple myeloma that developed during treatment of PLB in a type of T-cell. A 48-yr-old man was diagnosed as T-cell PLB, stage IE, 18 months ago. The patient received the chemoradiotherapy and salvage chemotherapy for PLB. However, the lymphoma progressed with generalized bone pain, and laboratory findings showed bicytopenia and acute renal failure. On bone marrow biopsy, the patient was diagnosed as having multiple myeloma newly developed with primary T-cell lymphoma of bone. In spite of chemotherapy, the patient died of renal failure.
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Affiliation(s)
- Jun-Eul Hwang
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Hee Cho
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ok-Ki Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Se-Ryeon Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Sook Ahn
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Duk-Hwan Yang
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeo-Kyeoung Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Je-Jung Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyeoung-Joon Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ik-Joo Chung
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
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Scuotto A, Rotondo M, Conforti R, Nastro A, Natale M, D’Avanzo R, Cirillo S. Primary lymphoma of the skull base. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ejrex.2008.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abdelwahab IF, Hoch B, Hermann G, Bianchi S, Klein MJ, Springfield DS. Primary periosteal lymphoma--rare and unusual. Skeletal Radiol 2007; 36:335-9. [PMID: 16534637 DOI: 10.1007/s00256-006-0096-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2006] [Accepted: 01/23/2006] [Indexed: 02/02/2023]
Abstract
We describe a primary periosteal lymphoma that involved only the periosteum without affecting the adjacent medulla or the regional lymph nodes. No other lymphomatous foci were found in either the distant lymph nodes or viscera. This unusual presentation simulates the imaging appearance of surface lesions of bone, namely benign and malignant tumors, and departs from the typical appearance of primary lymphoma of bone. Therefore, this rare type of lymphoma should be considered in the differential diagnosis of surface bone lesions.
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Affiliation(s)
- Ibrahim Fikry Abdelwahab
- Department of Radiology, Coney Island Hospital, affiliated with Downstate School of Medicine, CUNY, New York, NY, USA
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Maruyama D, Watanabe T, Beppu Y, Kobayashi Y, Kim SW, Tanimoto K, Makimoto A, Kagami Y, Terauchi T, Matsuno Y, Tobinai K. Primary Bone Lymphoma: A New and Detailed Characterization of 28 Patients in a Single-Institution Study. Jpn J Clin Oncol 2007; 37:216-23. [PMID: 17472971 DOI: 10.1093/jjco/hym007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence of primary bone lymphoma (PBL) is so rare that many of its aspects remain unknown. A number of studies have been reported from Western countries, but only a few reports are available from Asia. METHODS We retrospectively analyzed 28 consecutive patients diagnosed with PBL initially treated at our hospital between 1995 and 2004. All patients underwent chemotherapy with half receiving radiotherapy as their initial treatment. A log-rank test was used in a univariate analysis to identify factors affecting overall survival. RESULTS Fifteen (54%) patients were male and 13 (46%) female with a median age of 47 (range: 5-81). Although 19 (68%) patients had diffuse large B-cell lymphoma (DLBCL), other histopathological subtypes (three B-lymphoblastic lymphoma, two anaplastic large cell lymphoma, two indolent B-cell lymphoma, one NK/T-cell lymphoma (NTCL) and one Hodgkin lymphoma) were also included. The pelvis was the most frequently involved site (54%). While 68% of patients had stage IV disease, none of them showed bone marrow involvement at their initial diagnosis. Despite 61% high intermediate-risk and high-risk patients based on the International Prognostic Index, the estimated 3-year overall and progression-free survival rates were 84% and 77%, respectively. Only 'histopathological subtype (immunoblastic variant of DLBCL or NTCL versus others)' and 'response to initial treatment (progression versus remission)' were factors significantly affecting overall survival. CONCLUSIONS Although the total number of patients was relatively small, the detailed clinical data analyses presented here revealed several new characteristics of PBL and some aspects that may be unique to Japanese patients.
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Affiliation(s)
- Dai Maruyama
- Hematology and Stem Cell Transplantation Division, Cancer Center Hospital, Tokyo, Japan
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Ford DR, Wilson D, Sothi S, Grimer R, Spooner D. Primary Bone Lymphoma — Treatment and Outcome. Clin Oncol (R Coll Radiol) 2007; 19:50-5. [PMID: 17305254 DOI: 10.1016/j.clon.2006.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS A retrospective review of patients with histologically confirmed primary bone lymphoma (PBL) diagnosed and treated at a single tertiary referral centre between 1985 and 2003. MATERIALS AND METHODS The medical records of all patients treated for histologically primary bone lymphoma were identified using the hospital data base. Data was obtained on patient demographics, stage, treatment and outcome. RESULTS Twenty-two patients with PBL were identified. Seventeen had localised disease and five had multifocal bone involvement. The median age was 50 years. Of the patients who could be graded according to the International Prognostic Index (IPI), 12 cases were classified as low risk, seven as intermediate risk and one as high risk. All patients received chemotherapy; 19 with an anthracycline-containing regimen. Eighteen patients were treated with radiotherapy to a median total dose of 40 Gy (range 30-50 Gy). Three patients had surgery instead of radiotherapy as local treatment (one fibulectomy and two endoprosthetic replacements). The median follow-up was 84.5 months (range 3-206 months). The overall 10-year survival was 74%; 92% for low-risk IPI vs 73% for intermediate-risk IPI (P = 0.27). The 10-year relapse-free survival was 85% overall and 83% for both low- and intermediate-risk IPI (P = 0.87). Local relapse was seen in one patient. Orthopaedic complications occurred in two patients--one developed a pathological fracture after biopsy before radiotherapy and the other developed avascular necrosis outside the irradiated area. CONCLUSIONS Combined modality treatment for PBL results in good local control and survival rates with acceptable toxicity.
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Affiliation(s)
- D R Ford
- Oncology Centre, Queen Elizabeth Medical Centre, Birmingham B15 2TH, UK.
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