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Panagopoulos A, Solou K, Symeonidis A, Verigou E, Kouroukli O, Zolota V, Kokkalis ZT. Delayed diagnosis of a primary diffuse large B-cell lymphoma of the humeral head, presenting as pathological fracture: a case report and review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:299-311. [PMID: 38706663 PMCID: PMC11065756 DOI: 10.1016/j.xrrt.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Andreas Panagopoulos
- Department of Orthopaedics, University Hospital of Patras, Medical School, Patras, Greece
| | - Konstantina Solou
- Department of Orthopaedics, University Hospital of Patras, Medical School, Patras, Greece
| | - Argiris Symeonidis
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Medical School, Patras, Greece
| | - Evgenia Verigou
- Hematology Division, Department of Internal Medicine, University Hospital of Patras, Medical School, Patras, Greece
| | - Olga Kouroukli
- Department of Pathology, University Hospital of Patras, Medical School, Patras, Greece
| | - Vasiliki Zolota
- Department of Pathology, University Hospital of Patras, Medical School, Patras, Greece
| | - Zinon T. Kokkalis
- Department of Orthopaedics, University Hospital of Patras, Medical School, Patras, Greece
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Abdoh MG, Ajlan B, Basurrah AA, Al-Saiari S, Mujtaba SS, Rawah E, Brinji Z, Atteiah A, Farag AA. Primary Calvarial Lymphoma: A Case Report. Cureus 2024; 16:e55210. [PMID: 38558616 PMCID: PMC10981205 DOI: 10.7759/cureus.55210] [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: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Calvarial lymphoma is radiologically similar in many respects to meningiomas, solid fibrous tumours, osteomyelitis, and metastatic carcinomas. Even though it is an extremely rare phenomenon, the initial suspicion and detection of calvarial lymphoma are paramount to establishing a correct diagnosis which helps to determine an appropriate management strategy. We present an illustrative rare case of primary calvarial lymphoma along with a literature review focusing on the best management strategy for this rare entity. A 45-year-old female presented to our center in March 2022. She had a history of forehead swelling, which was progressively increasing in size over time. The metastatic workup and bone marrow biopsy were negative. Initially, extensive surgery was planned to resect the lesion, but after a discussion with the multidisciplinary team, a biopsy of the lesion was taken, which revealed a large B-cell lymphoma. It is prudent to consider calvarial lymphoma in the differential diagnosis of a progressively growing skull lesion, which may obviate the need for large resective surgery. A biopsy plus chemoradiation may be all that is required.
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Affiliation(s)
- Mohammad G Abdoh
- Neurosurgery Department, King Abdullah Medical City, Makkah, SAU
| | - Balgees Ajlan
- Neurosurgery Department, Dalhousie University, Halifax, Nova Scotia, CAN
| | | | | | | | - Elham Rawah
- Radiology Department, King Abdullah Medical City, Makkah, SAU
| | - Zaina Brinji
- Radiology Department, King Abdullah Medical City, Makkah, SAU
| | | | - Ahmed A Farag
- Neurosurgery Department, King Abdullah Medical City, Makkah, SAU
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Tsujioka Y, Handa A, Nishimura G, Nozaki T, Miyazaki O, Kono T, Bixby SD, Jinzaki M. Pediatric Ribs at Chest Radiography: Normal Variants and Abnormalities. Radiographics 2023; 43:e230076. [PMID: 37943700 DOI: 10.1148/rg.230076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Normal variants and abnormalities of the ribs are frequently encountered on chest radiographs. Accurate identification of normal variants is crucial to avoid unnecessary investigations. A meticulous evaluation of rib abnormalities can provide valuable insights into the patient's symptoms, and even when no osseous condition is suspected, rib abnormalities may offer critical clues to underlying conditions. Rib abnormalities are associated with various conditions, including benign tumors, malignant tumors, infectious and inflammatory conditions, vascular abnormalities, metabolic disorders, nonaccidental injuries, malformation syndromes, and bone dysplasias. Abnormalities of the ribs are classified into three groups based on their radiographic patterns: focal, multifocal, and diffuse changes. Focal lesions are further subdivided into nonaggressive lesions, aggressive lesions, and infectious and inflammatory disorders. Radiologists should be aware of individual disorders of the pediatric ribs, including their imaging findings, relevant clinical information, and underlying pathogenesis. Differential diagnoses are addressed as appropriate. Since chest radiographs can suffice for diagnosis in certain cases, the authors emphasize a pattern recognition approach to radiographic interpretation. However, additional cross-sectional imaging may be necessary for focal lesions such as tumors or inflammatory conditions. Awareness of disease-specific imaging findings helps ascertain the nature of the lesion and directs appropriate management. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Yuko Tsujioka
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Atsuhiko Handa
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Gen Nishimura
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Taiki Nozaki
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Osamu Miyazaki
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Tatsuo Kono
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Sarah D Bixby
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
| | - Masahiro Jinzaki
- From the Department of Radiology, Keio University School of Medicine, Tokyo, Japan (Y.T., T.N., M.J.); Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan (Y.T., T.K.); Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115 (A.H., S.D.B.); Department of Radiology, Musashino-Yowakai Hospital, Tokyo, Japan (G.N.); and Department of Radiology, National Center for Child Health and Development, Tokyo, Japan (O.M.)
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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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Otsuka Y, Nakano Y, Omura D, Hasegawa K, Otsuka F. Primary bone lymphoma presenting as fever of unknown origin. J Gen Fam Med 2022; 23:280-281. [PMID: 35800636 PMCID: PMC9249926 DOI: 10.1002/jgf2.529] [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: 10/07/2021] [Revised: 01/06/2022] [Accepted: 01/30/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yuki Otsuka
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Yasuhiro Nakano
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Daisuke Omura
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kou Hasegawa
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Fumio Otsuka
- Department of General Medicine Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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Cheung H, Yechoor A, Behnia F, Abadi AB, Khodarahmi I, Soltanolkotabi M, Shafiei M, Chalian M. Common Skeletal Neoplasms and Nonneoplastic Lesions at 18F-FDG PET/CT. Radiographics 2021; 42:250-267. [PMID: 34919467 DOI: 10.1148/rg.210090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Numerous primary and metastatic osseous lesions and incidental osseous findings are encountered at fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT. These lesions show varying degrees of FDG uptake. Malignancies are generally more FDG avid than are benign lesions, but many exceptions exist. Although aggressive lesions tend to be more FDG avid than nonaggressive lesions, this concept holds true particularly for lesions of the same histologic subtype. In addition, some benign osseous processes such as Paget disease have variable degrees of FDG avidity on the basis of disease metabolic activity. This creates a diagnostic dilemma for radiologists and clinicians, especially in patients with known malignancies, and can result in unnecessary diagnostic imaging or interventions for incidental osseous lesions. Evaluation of morphologic CT characteristics of osseous lesions at FDG PET/CT can be a valuable adjunct to metabolic analysis to further characterize lesions, enhance diagnostic and staging accuracy, and avoid unnecessary invasive biopsy procedures. The authors review the common primary and metastatic bone lesions at FDG PET/CT, with an emphasis on morphologic CT assessment of lesions to help narrow the differential diagnosis. Imaging manifestations of common incidental nonneoplastic bone lesions at FDG PET/CT are discussed to provide information on differentiation of these lesions from osseous neoplasms. The guidelines of the National Comprehensive Cancer Network (NCCN) for common primary osseous malignancies are also summarized. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hoiwan Cheung
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Alekhya Yechoor
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Fatemeh Behnia
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Alireza Behrad Abadi
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Iman Khodarahmi
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Maryam Soltanolkotabi
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Mehrzad Shafiei
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Majid Chalian
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
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Spinal Manifestation of Malignant Primary (PLB) and Secondary Bone Lymphoma (SLB). ACTA ACUST UNITED AC 2021; 28:3891-3899. [PMID: 34677250 PMCID: PMC8534567 DOI: 10.3390/curroncol28050332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 01/10/2023]
Abstract
Manifestation of malignant lymphoma in the spine is rare; there have only been a few cases reported in the literature. Due to its rarity, there is no gold standard for the management of patients suffering from spinal lymphoma manifestations. Methods: We retrospectively reviewed the data for 37 patients (14 female, 23 male) with malignant lymphoma in the spine receiving intervention in our center from March 2006 until June 2020. Neurological impairment, pain, diagnostics, and/or surgical instability were the criteria for surgery in this patient cohort. Otherwise, only CT-guided biopsies were conducted. Analysis of the patient cohort was based on the Karnofsky performance status scale (KPSS), location of the lesion, spinal levels involved, spinal instability neoplastic score (SINS), surgical treatment, histopathological workup, adjuvant therapy, and overall survival. The following surgical procedures were performed: posterior stabilization and decompression in nine patients; decompression and/or tumor debulking in 18 patients; a two-staged procedure with dorsal stabilization and vertebral body replacement in four patients; decompression and biopsy in one patient; a two-stage procedure with kyphoplasty and posterior stabilization for one patient; posterior stabilization without decompression for one patient; a vertebroplasty and cement-augmented posterior stabilization for one patient; and a CT-guided biopsy alone for two patients. Twenty-one patients (56.78%) had ≥1 lesion in the thoracic spine, 10 patients (27.03%) had lesions in the lumbar spine, two patients had lesions in the cervicothoracic junction, two patients had lesions in the thoracolumbar junction, one patient had a lesion in the lumbosacral junction, and one patient had a lesion in the sacrum. The diagnoses of the histopathological workup were diffuse large B-cell lymphoma in 23 (62.16%) cases, indolent lymphoma in 11 (29.74%) cases, anaplastic T-cell lymphoma in one case (2.70%), T-cell lymphoma in one case (2.70%), and Burkitt lymphoma in one (2.70%) case. The median overall survival was 7.2 months (range 0.1–266.7 months). Pre- and postoperative KPSS scores were 70% (IQR 60–80%). Manifestation of malignant lymphomas in the spine is rare. Similar to the approach taken for spine metastases, a surgical intervention in cases of neurological impairment or manifest or potential instability is indicated, followed by chemoimmunotherapy and radiotherapy.
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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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Mremi A, Pyuza JJ, Ahmad B, Andongolile AA, Sadiq A, Yahaya JJ, Szuhai K, Hogendoorn PCW. Non-Hodgkin lymphoma of bone of the femur and humerus: a case report and review of the literature. Oxf Med Case Reports 2021; 2021:omab024. [PMID: 33959300 PMCID: PMC8082228 DOI: 10.1093/omcr/omab024] [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: 01/26/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Lymphoma of bone is a rare neoplasm composed of malignant lymphoid cells, producing a tumefactive lesion within bone. We report a 13-year-old male who presented with progressively increasing swellings at the right shoulder and right mid-thigh for one month. Radiological images revealed lytic destructive lesions associated with soft tissue masses in both sites and a pathological fracture on the right humerus. The patient had no significant medical history. Histological, immunohistochemical and fluorescent in-situ hybridization assessment of biopsies from the lesions confirmed the diagnosis of primary non-Hodgkin lymphoma of bone. Unfortunately, due to coronavirus disease 2019 outbreak, the patient was unable to follow-up treatment and died shortly after establishment of the diagnosis. Delay in diagnosis and treatment is of serious concern when it comes to improve the prognosis of patients with this disease.
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Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jeremia J Pyuza
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Bilal Ahmad
- Department of Orthopaedic Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Alice A Andongolile
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Adnan Sadiq
- Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - James J Yahaya
- Department of Biomedical Science, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Karoly Szuhai
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Toyota E, Taslimi S, Alkins R. Optimal Management of Calvarial Lymphoma: A Meta-Analysis. World Neurosurg 2021; 151:e484-e494. [PMID: 33901734 DOI: 10.1016/j.wneu.2021.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Calvarial lymphoma is an exceedingly rare phenomenon; the clinical presentation and imaging pattern mimic many diseases of the central nervous system. Several treatment approaches have been undertaken with variable use of surgery plus adjuvant chemotherapy and radiation; an optimal treatment algorithm has yet to be defined. The aim of this study was to better characterize management strategies and patient outcomes. METHODS An illustrative case was presented and a meta-analysis was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MEDLINE and Embase were searched for cases of calvarial lymphoma. Outcomes between patients who underwent open surgery and biopsy only were compared directly. RESULTS In an analysis from 1976 to 2019, 62 patients with a median age of 60 were included. The most common presentations were subcutaneous scalp mass (89%), headaches (26%), and focal neurological deficits (21%). Osteolytic changes on computed tomography were seen in 69% of patients with extension into either the intracranial or extracranial space in 97% of cases. Surgical excision was performed in 41 patients with a remission rate of 85% and a recurrence rate of 5%, which did not vary significantly from patients treated nonsurgically (remission in 75%, P = 0.479; recurrence in 0%, P = 1.000) CONCLUSIONS: In patients presenting with a progressively enlarging scalp mass, calvarial lymphoma should be in the differential diagnosis, as it can be effectively managed with a biopsy followed by chemotherapy and radiation. The role for open surgery may be limited.
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Affiliation(s)
- Eric Toyota
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston.
| | - Shervin Taslimi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Alkins
- Division of Neurosurgery, Department of Surgery, Kingston Health Sciences Centre, Queen's University, Kingston
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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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Stefanini FS, Gois FWC, de Arruda TCSB, Bitencourt AGV, Cerqueira WS. Primary bone lymphoma: pictorial essay. Radiol Bras 2020; 53:419-423. [PMID: 33304011 PMCID: PMC7720670 DOI: 10.1590/0100-3984.2019.0137] [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: 11/22/2022] Open
Abstract
Primary bone lymphoma is a rare neoplasm that can initially present as local pain, a palpable mass, and pathologic fracture. It can also be discovered as an incidental finding on an imaging examination. It is defined as a bone marrow tumor with no involvement of other sites, lasting at least six months. The diagnosis is confirmed by biopsy and immunohistochemical analysis. Although the imaging characteristics are nonspecific, there are certain findings that, when correlated with clinical and epidemiological aspects, can increase the level of suspicion of primary bone lymphoma. The classic imaging aspect is a bone lesion with a soft-tissue component that preserves the cortical layer more than would be expected given the invasive nature of the lesion. Magnetic resonance imaging is the best imaging method to evaluate the extent of involvement of adjacent compartments, whereas computed tomography depicts the cortical layer in greater detail, as well as being an important tool for biopsy guidance. Other imaging modalities are also discussed, such as X-ray, ultrasound, bone scintigraphy, and positron emission tomography/computed tomography. The aim of this paper is to describe the most common findings obtained with the various imaging methods used in patients with a confirmed diagnosis of primary bone lymphoma.
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Boffano M, Ratto N, Rezzoagli M, Conti A, Pellegrino P, Piana R. Belated Diagnosis of a Primary Bone Lymphoma of the Elbow: A Rare Case and Review of the Literature. CASE REPORTS IN ORTHOPEDIC RESEARCH 2020. [DOI: 10.1159/000509128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Primary non-Hodgkin bone lymphoma (PBL) is a rare disease that accounts for <2% of all lymphomas in adults. PBL can be monostotic or polyostotic, mainly causing destructive and lytic bone lesions frequently located in the femur, humerus, and pelvis. PBL is rarely considered a differential diagnosis of the osteolytic tumor. In addition, PBL is not uncommonly diagnosed with delay because patients do not experience symptoms nor show objective abnormalities in the early stage of disease. Here, we reported a 60-year-old woman with a PBL of the elbow.
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Erny D, Taschner U, Nakagawa J, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference : Back Pain and Rapidly Progressing Gait Disorder in a 70-year-old Patient. Clin Neuroradiol 2020; 30:647-653. [PMID: 32845352 PMCID: PMC7471148 DOI: 10.1007/s00062-020-00945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- D Erny
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - U Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - J Nakagawa
- Department of Neurosurgery, Medical Centre, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.
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15
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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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The incidence and mortality trends of bone lymphoma in the United States: An analysis of the Surveillance, Epidemiology, and End Results database. J Bone Oncol 2020; 24:100306. [PMID: 32760645 PMCID: PMC7390813 DOI: 10.1016/j.jbo.2020.100306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
The incidence rates of bone lymphoma had sharply increased for the early decades. The incidence trend of bone lymphoma has stabilized in recent years. The mortality had sharply increased from 1985 to 2016 without a turn point. The incidence and mortality by various characteristics had similar patterns.
Background In recent years, studies on bone lymphoma and its histologic types have reached a mature stage. However, reports on the incidence and incidence-based mortality trends of bone lymphoma are scanty. Methods Patients with bone lymphoma in the U.S. were selected from Surveillance, Epidemiology, and End Results (SEER) database (1975–2016), and categorized based on age, sex, race, tumor location, SEER Historic Stage A and histologic type. Data on the incidence (1975–2016) and incidence-based mortality (1985–2016) were directly obtained from the SEER program. Annual percentage change (APC) and 95% confidence intervals (CIs) were calculated using the joinpoint regression analysis program. Results Overall, 13,058 bone lymphoma cases diagnosed in resident patients of the U.S. were included in incidence analysis between 1975 and 2016 as follows: 6080 cases in 1975–1999, 3796 cases in 2000–2009, and 3182 cases in 2010–2016. Of these cases, 6888 died of bone lymphoma between 1985 and 2016. The overall incidence rates dramatically increased from 0.89 per 100,000 person-years in 1975 to 1.36 per 100,000 person-years in 2016. Incidence trend sharply increased from 1975 to 2009, and then stabilized between 2009 and 2016. Overall incidence-based mortality trends sharply increased from 1985 to 2016 without a joinpoint. Following the demographic and tumor characteristics, the trends of incidence and incidence-based mortality exhibited similar patterns. Conclusion Considering various characteristics (age, sex, race, tumor location, SEER Historic Stage A, and histologic type), we established that the incidence trend of bone lymphoma has sharply been increasing over the decades, however, in the recent years, the trend has stabilized. Besides, between 1985 and 2016, the incidence-based mortality had been sharply increasing without a turning point. These findings could give insights for clinicians to elaborately assess the epidemiology and risk factors of bone lymphoma.
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17
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Clary D, Ali A, Syed I. Challenges of interpreting the musculoskeletal manifestation of lymphoma: A case report. Radiography (Lond) 2020; 27:243-246. [PMID: 32331926 DOI: 10.1016/j.radi.2020.04.004] [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: 02/08/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary Bone Lymphoma can be challenging to interpret even for the experienced reviewer. This case demonstrates the subtle multimodality appearances encountered. CASE SUMMARY a gentleman in his late 70s with one week history of groin pain underwent plain radiography and subsequent further imaging. Only following biopsy was the diagnosis of primary bone lymphoma made for which the patient has received successful treatment. CONCLUSION This case demonstrates the difficulties in identifying lymphoma when seen within the musculoskeletal system. It also provides opportunity to reflect on the importance of initial imaging, good quality history and understanding of differentials.
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Affiliation(s)
- D Clary
- Department of Radiology, Basildon and Thurrock University Hospitals, NHS Foundation Trust, Nethermayne, Basildon, Essex, SS16 5NL, UK.
| | - A Ali
- Basildon and Thurrock University Hospitals, NHS Foundation Trust, Nethermayne, Basildon, Essex, SS16 5NL, UK.
| | - I Syed
- Department of Radiology, Basildon and Thurrock University Hospitals, NHS Foundation Trust, Nethermayne, Basildon, Essex, SS16 5NL, UK.
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18
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Ranjan S, Rathore A, Kapoor R, Singh J, Arvind P, Pandya T, Kumar N. Clinicoepidemiological profile of extranodal lymphoma: The experience of a tertiary care center in India. CLINICAL CANCER INVESTIGATION JOURNAL 2020. [DOI: 10.4103/ccij.ccij_77_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Jadidi J, Behzadi F, Sighary M, Alshal M, Kolla S, Lehto SA. Primary bone lymphoma of patella: A case report and review of literature. Radiol Case Rep 2019; 14:1561-1565. [PMID: 31737136 PMCID: PMC6849352 DOI: 10.1016/j.radcr.2019.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022] Open
Abstract
Primary bone lymphoma (PBL) is rare bone disease that accounts for very small number of all primary bone tumors. Among the described sites of PBLs, the patella is an extremely rare example. To date, only a few cases of PBL affecting the patella have been reported. Clinically, these tumors have very similar presentation of pain, decreased range of motion and swelling and, sometimes, pathologic fractures. On radiographs, skeletal lymphoma commonly manifests as osteolytic lesions with ill-defined margins affecting the metaphysis of axial long bones. We present a rare case of patellar adult T-cell lymphoma/leukemia in a 58-year-old female who presented with left-knee pain and swelling. Computed tomography and magnetic resonance imaging revealed diffuse marrow replacement by a lesion with aggressive features. PET scan demonstrated neoplastic range hypermetabolic FDG uptake within this lesion. Ultrasound-guided biopsy was consistent with PBL.
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Affiliation(s)
- Jami Jadidi
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Fardad Behzadi
- Department of Radiology, Brigham Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Maziar Sighary
- Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Mohamed Alshal
- Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Srinivas Kolla
- Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
| | - Scott A Lehto
- Department of Radiology, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY 11203, USA
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20
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Yamamoto S, Tanaka T, Sato K, Denda R, Kumagae Y, Sekiya H, Kojima M. Primary non-germinal center B-cell-like diffuse large B-cell lymphoma arising from the patella. J Orthop Sci 2019; 24:568-572. [PMID: 28209399 DOI: 10.1016/j.jos.2017.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Shun Yamamoto
- Department of Orthopaedic Surgery, NHO Utsunomiya National Hospital, Shimookamotocho 2160, Utsunomiya, Tochigi, 329-1193, Japan.
| | - Takaaki Tanaka
- Department of Orthopaedic Surgery, NHO Utsunomiya National Hospital, Shimookamotocho 2160, Utsunomiya, Tochigi, 329-1193, Japan.
| | - Kazuya Sato
- Department of Hematology, Jichi Medical University Hospital, Yakushiji, 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Ryosuke Denda
- Department of Orthopaedic Surgery, NHO Utsunomiya National Hospital, Shimookamotocho 2160, Utsunomiya, Tochigi, 329-1193, Japan
| | - Yoshio Kumagae
- Department of Orthopaedic Surgery, NHO Utsunomiya National Hospital, Shimookamotocho 2160, Utsunomiya, Tochigi, 329-1193, Japan
| | - Hitoshi Sekiya
- Department of Orthopaedic Surgery, Jichi Medical University Hospital, Yakushiji, 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Masaru Kojima
- Department of Histopathology, Dokkyo Medical University Hospital, Kitakobayashi 880, Mibumachi, 329-0293, Shimotsuga, Tochigi, Japan.
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Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To determine the prognostic indicators in patients with bone lymphoma of the spine. SUMMARY OF BACKGROUND DATA To date, prognosis for patients with spinal bone lymphoma is based on results from small series. Large population-based observational studies are lacking. METHODS The Surveillance, Epidemiology, and End Results Registry was used to identify all patients with bone lymphoma of the spine from 1995 through 2014. Overall survival (OS) and disease-specific survival (DSS) estimates were obtained using the Kaplan-Meier method and compared across groups using log-rank test. Association of survival with variables was assessed using Cox proportional-hazards regression analysis. Nomograms were established and validated by R software. RESULTS A total of 1338 patients were identified with bone lymphoma of the spine. The trend of incidence was relative steady from 1995 to 2014. The mean and median age of diagnosis was 62.9 and 66.0 years, respectively. Men constituted a slightly greater proportion (55.5%) of the cohort. The most common subtype of lymphoma was diffuse large B-cell lymphoma (59.8%). The 5- and 10-year OS rates for those patients were 60.6% and 44.7%, respectively. Multivariate analysis revealed that age, sex, marital status, and race were sociodemographic predictors of OS and DSS. Extracompartmental invasion of tumor and stage IV of lymphoma were significantly correlated with poor OS and DSS. Patients without surgery or radiotherapy was linked to a poor OS. Both OS and DSS of patients with spinal bone lymphoma improved in 2005 to 2014 when compared to 1995 to 2004. In addition, pretreatment nomograms to predict 5- and 10-year survival were established. CONCLUSION The findings of this study provide population-based estimates of the prognosis for patients with spinal bone lymphoma. Both sociodemographic and clinical factors may have an impact on the outcomes. LEVEL OF EVIDENCE 4.
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Ugga L, Cuocolo R, Cocozza S, Ponsiglione A, Stanzione A, Chianca V, D'Amico A, Brunetti A, Imbriaco M. Spectrum of lytic lesions of the skull: a pictorial essay. Insights Imaging 2018; 9:845-856. [PMID: 30232766 PMCID: PMC6206388 DOI: 10.1007/s13244-018-0653-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/18/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
Abstract Lytic lesions of the skull include a wide range of diseases, ranging from benign conditions such as arachnoid granulations or vascular lacunae, to aggressive malignant lesions such as lymphomas or metastases. An early and correct characterisation of the nature of the lesion is, therefore, crucial, in order to achieve a fast and appropriate treatment option. In this review, we present the radiological appearance of the most frequent lytic lesions of the skull, describing findings from different imaging modalities (plain X-rays, CT and MRI), with particular attention to diagnostic clues and differential diagnoses. Teaching Points • Osteolytic skull lesions may be challenging to diagnose. • Association of different imaging techniques may aid image interpretation. • Clinical information and extensive knowledge of possible differential diagnoses is essential. • Some osteolytic tumours, although benign, may present as locally aggressive lesions. • Malignant lesions require accurate staging, followed by variable treatment approaches.
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Affiliation(s)
- Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Renato Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Vito Chianca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
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Moritani K, Nakano N, Yonezawa S, Ochi F, Tauchi H, Eguchi-Ishimae M, Eguchi M, Ishii E, Nagai K. Usefulness of positron emission tomography-CT for diagnosis of primary bone marrow lymphoma in children. Pediatr Hematol Oncol 2018; 35:125-130. [PMID: 29648910 DOI: 10.1080/08880018.2018.1459984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Primary bone marrow lymphoma (PBML) is hard to diagnose in children, due to the difficult identification of malignant cells in bone marrow. The first case, a 5-year-old boy, showed knee swelling with an intermittent fever. The second case, a 12-year-old girl, showed fever of unknown origin without lymphadenopathy or hepatosplenomegaly. In both cases, the diagnosis was not confirmed despite the repeated bone marrow aspirations. Finally, bone marrow aspiration and biopsy at the positive site by positron emission tomography (PET)-CT contributed to definitive diagnosis of PBML. The PET-CT is useful for the accurate diagnosis of PBML in children with non-specific symptoms.
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Affiliation(s)
- Kyoko Moritani
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Naoko Nakano
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Sachiko Yonezawa
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Fumihiro Ochi
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Hisamichi Tauchi
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | | | - Mariko Eguchi
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Eiichi Ishii
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
| | - Kozo Nagai
- a Department of Pediatrics , Ehime University Graduate School of Medicine , Ehime , Japan
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Sato S, Kaneuchi Y, Hakozaki M, Yamada H, Kawana S, Hasegawa O, Konno S. Primary malignant lymphoma of the talus: A case report and review of the literature. Mol Clin Oncol 2017; 7:574-578. [PMID: 28855991 PMCID: PMC5574142 DOI: 10.3892/mco.2017.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/03/2017] [Indexed: 12/28/2022] Open
Abstract
Malignant lymphoma commonly occurs in adults, with a peak incidence between the seventh and ninth decades of life. Although malignant lymphoma usually occurs in the lymph nodes, it rarely occurs primarily in the bone. We herein describe an extremely rare case of primary malignant lymphoma of the talus in a 74-year-old man. Although plain radiographs showed no abnormality, gadolinium-enhanced magnetic resonance imaging (MRI) revealed a well-circumscribed intra- and extraosseous tumor of the talus. 18F-fluorodeoxyglucose (FDG) positron emission tomography/MRI revealed a marked increase of FDG uptake in the right ankle and the right inguinal lymph nodes. As the tumor was diagnosed as diffuse large B-cell lymphoma by core needle biopsy, combination therapy with chemo- and radiotherapy was initiated. The patient achieved complete remission, with no sign of recurrence at 8 months after initial chemoradiotherapy. Since primary malignant lymphoma of the bone is chemo- and radiosensitive and has a good prognosis, accurate staging by radiological investigation as well as correct pathological diagnosis by biopsy are required for optimal treatment.
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Affiliation(s)
- Shunsuke Sato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hitoshi Yamada
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Satoshi Kawana
- Department of Pathology and Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Osamu Hasegawa
- Department of Radiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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25
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Li YJ, Li YF, Du JW, Dong LH, Gao X, Li GP, Wei XD, Song YP. [Clinical features of 11 cases of primary bone lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:597-601. [PMID: 28810328 PMCID: PMC7342277 DOI: 10.3760/cma.j.issn.0253-2727.2017.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
目的 探讨原发性骨淋巴瘤患者的临床特征、治疗及预后。 方法 回顾性分析11例原发性骨淋巴瘤患者的临床资料,对其临床特征,诊治过程及预后进行分析总结。 结果 11例患者中女7例,男4例,中位发病年龄45岁,仅1例患者以无痛性肿块起病,其余均以骨痛为首发症状,主要病理类型为弥漫大B细胞淋巴瘤和间变大细胞淋巴瘤。Ann Arbor临床分期ⅠE期3例,ⅡE期2例,ⅣE期6例。6例患者采取化疗联合放疗,2例行骨关节置换术联合化疗,3例选择单纯化疗。11例患者经初始治疗后5例达完全缓解,4例达部分缓解,2例疾病稳定。中位随访时间为21(6~58)个月,中位无进展生存期为17(5~58)个月。 结论 原发性骨淋巴瘤诊断时多为晚期,临床表现及影像学检查缺乏特异性,目前治疗主要采取以化疗为主的综合治疗,预后相对较好。
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Affiliation(s)
- Y J Li
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
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Zhang X, Zhu J, Song Y, Ping L, Zheng W. Clinical characterization and outcome of primary bone lymphoma: a retrospective study of 61 Chinese patients. Sci Rep 2016; 6:28834. [PMID: 27357354 PMCID: PMC4928085 DOI: 10.1038/srep28834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/31/2016] [Indexed: 11/11/2022] Open
Abstract
Primary bone lymphoma(PBL) is a rare disease. To assess the clinical characteristics, outcome, and prognostic factors of this entity in Chinese population, we retrospectively analyzed 61 PBL patients initially treated in our institution between 1997 and 2014. The median age was 45 years. The most common histological subtype was diffuse large B-cell lymphoma (DLBCL) (55.7%), followed by T-cell lymphoma (18.0%). All patients underwent systemic chemotherapy as initial treatment while 24 patients (39.3%) were additionally treated with radiotherapy. The 5-year overall survival (OS) and the 5-year progression-free survival (PFS) rates of 57 cases with completed follow-up were 52.3% and 40.1%, respectively. In further analysis of the primary bone DLBCL (PB-DLBCL) subgroup, the 5-year OS and PFS rates were 53.0% and 47.0%, and a multivariable analysis revealed that baseline Eastern Cooperative Oncology Group (ECOG) score and response to initial treatment (complete remission versus no complete remission) were independent prognostic factors for both OS and PFS. The proportion of T-cell lymphoma is higher in China than in western populations. High baseline ECOG scores (≥2) and unachieved CR in initial therapy were factors for poor PB-DLBCL prognosis. The role of radiotherapy and rituximab in PLB therapy remains to be confirmed in further investigation.
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Affiliation(s)
- XuanYe Zhang
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Jun Zhu
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - YuQin Song
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - LingYan Ping
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - Wen Zheng
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
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Ishiguro K, Hayashi T, Aoki Y, Murakami R, Ikeda H, Ishida T. Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorder Presenting as Primary Bone Lymphoma in a Patient with Rheumatoid Arthritis. Intern Med 2016; 55:2259-64. [PMID: 27523005 DOI: 10.2169/internalmedicine.55.6684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary bone lymphoma (PBL) is a rare disorder. We herein present a case of other iatrogenic immunodeficiency-associated lymphoproliferative disorder (OIIA-LPD) presenting as PBL. A 63-year-old woman was diagnosed with rheumatoid arthritis and had been treated with methotrexate for seven years. Two months before admission, she suffered from pain in the limbs. Magnetic resonance imaging revealed multiple irregular lesions in the bones of the limbs, which showed an uptake of (18)F-FDG on positron emission tomography. A biopsy of the right radius revealed diffuse large B-cell lymphoma, leading to the diagnosis of OIIA-LPD. She received rituximab-containing regimens resulting in a complete response.
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Affiliation(s)
- Kazuya Ishiguro
- Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University School of Medicine, Japan
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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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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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Results of a Prospective Study of High-Dose or Conventional Anthracycline-Cyclophosphamide Regimen Plus Radiotherapy for Localized Adult Non-Hodgkin's Primary Bone Lymphoma. Adv Hematol 2014; 2014:512508. [PMID: 24723955 PMCID: PMC3958647 DOI: 10.1155/2014/512508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 01/20/2014] [Accepted: 01/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Primary bone lymphoma (PBL) is a rare entity that has only been reviewed in one prospective and small retrospective studies, from which it is difficult to establish treatment guidelines. We prospectively evaluated high-dose or conventional anthracycline-cyclophosphamide dose and radiotherapy for PBL. Patients and Methods. The GOELAMS prospective multicenter study (1986-1998) enrolled adults with localized high-grade PBL according to age and performance status (PS). Patients <60 years received a high-dose CHOP regimen (VCAP) and those ≥60 years a conventional anthracycline-cyclophosphamide regimen (VCEP-bleomycin); all received intrathecal chemotherapy and local radiotherapy. Results. Among the 26 patients included (VCAP: 19; VCEP-bleomycin: 7), 39% had poor PS ≥2. With a median follow-up of 8 years, overall survival, event-free survival, and relapse-free survival were 64%, 62%, and 65%, respectively, with no significant difference between treatment groups. Poor PS was significantly associated with shorter OS and EFS. Conclusions. Our results confirm the efficacy of our age-based therapeutic strategy. High-doses anthracycline-cyclophosphamide did not improve the outcome. VCEP-bleomycin is effective and well tolerated for old patients. The intensification must be considered for patients with PS ≥2, a poor prognostic factor.
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Wu H, Zhang L, Shao H, Sokol L, Sotomayor E, Letson D, Bui MM. Prognostic significance of soft tissue extension, International Prognostic Index, and multifocality in primary bone lymphoma: a single institutional experience. Br J Haematol 2014; 166:60-8. [DOI: 10.1111/bjh.12841] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Huanwen Wu
- Department of Pathology; Peking Union Medical College Hospital; Chinese Academy of Medical Science; Beijng China
| | - Ling Zhang
- Department of Hematopathology and Laboratory Medicine; Moffitt Cancer Center; Tampa FL USA
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine; Moffitt Cancer Center; Tampa FL USA
| | - Lubomir Sokol
- Department of Malignant Hematology; Moffitt Cancer Center; Tampa FL USA
| | - Eduardo Sotomayor
- Department of Malignant Hematology; Moffitt Cancer Center; Tampa FL USA
| | - Douglas Letson
- Department of Sarcoma; Moffitt Cancer Center; Tampa FL USA
| | - Marilyn M. Bui
- Department of Sarcoma; Moffitt Cancer Center; Tampa FL USA
- Department of Anatomic Pathology; Moffitt Cancer Center; Tampa FL USA
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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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Govi S, Christie D, Mappa S, Marturano E, Bruno-Ventre M, Messina C, Medina EAG, Porter D, Radford J, Heo DS, Park Y, Pro B, Jayamohan J, Pavlakis N, Zucca E, Gospodarowicz M, Ferreri AJM. The clinical features, management and prognosis of primary and secondary indolent lymphoma of the bone: a retrospective study of the International Extranodal Lymphoma Study Group (IELSG #14 study). Leuk Lymphoma 2014; 55:1796-9. [DOI: 10.3109/10428194.2013.853298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Messina C, Ferreri AJM, Govi S, Bruno-Ventre M, Gracia Medina EA, Porter D, Radford J, Heo DS, Park HY, Pro B, Jayamohan J, Visco C, Scarfò L, Zucca E, Gospodarowicz M, Christie D. Clinical features, management and prognosis of multifocal primary bone lymphoma: a retrospective study of the international extranodal lymphoma study group (the IELSG 14 study). Br J Haematol 2014; 164:834-40. [DOI: 10.1111/bjh.12714] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/01/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Carlo Messina
- Unit of Lymphoid Malignancies; Department of Onco-Haematology; San Raffaele Scientific Institute; Milan Italy
| | - Andrés J. M. Ferreri
- Unit of Lymphoid Malignancies; Department of Onco-Haematology; San Raffaele Scientific Institute; Milan Italy
| | - Silvia Govi
- Unit of Lymphoid Malignancies; Department of Onco-Haematology; San Raffaele Scientific Institute; Milan Italy
| | - Marta Bruno-Ventre
- Unit of Lymphoid Malignancies; Department of Onco-Haematology; San Raffaele Scientific Institute; Milan Italy
| | - Elías A. Gracia Medina
- Servicio de Oncología Médica; Instituto Nacional de Oncología y Radiobiología; La Habana Cuba
| | | | | | - Dae S. Heo
- Seoul National University Hospital; Seoul Korea
| | | | - Barbara Pro
- Division of Hematology; M.D. Anderson Cancer Centre; Houston TX USA
| | | | - Carlo Visco
- Department of Haematology; San Bortolo Hospital; Vicenza Italy
| | - Lydia Scarfò
- Unit of Lymphoid Malignancies; Department of Onco-Haematology; San Raffaele Scientific Institute; Milan Italy
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - Mary Gospodarowicz
- Department of Radiation Oncology; Princess Margaret Hospital; Ontario Cancer Institute; Toronto ON Canada
| | - David Christie
- Premion and Bond University; Inland Dr.; Tugun QLD Australia
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Mugera C, Suh KJ, Huisman TAGM, Weber K, Belzberg AJ, Carrino JA, Chhabra A. Sclerotic lesions of the spine: MRI assessment. J Magn Reson Imaging 2013; 38:1310-24. [PMID: 24123379 DOI: 10.1002/jmri.24247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 05/07/2013] [Indexed: 01/08/2023] Open
Abstract
Sclerotic (T2 dark) lesions of the spine are infrequent and, as a result, these are often missed or misdiagnosed. Plain films may not be always available during magnetic resonance imaging (MRI) readout. Knowledge of such lesions and their imaging appearances on MRI evaluation is essential for a reader. Additionally, a systematic approach is important to accurately diagnose these lesions. In this article we discuss the various causes of spinal sclerotic lesions, describe their MRI characteristics with relevant case examples, and outline a systematic approach to their evaluation.
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Sanjayan R, Prabhakaran P, Surendran A, Narayanan G. Non-Hodgkin lymphoma of the cranial vault. Am J Med 2013; 126:e7-8. [PMID: 23910518 DOI: 10.1016/j.amjmed.2013.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Rajitha Sanjayan
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum, India
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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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Scoccianti G, Rigacci L, Puccini B, Campanacci DA, Simontacchi G, Bosi A, Capanna R. Primary lymphoma of bone: outcome and role of surgery. INTERNATIONAL ORTHOPAEDICS 2013; 37:2437-42. [PMID: 23974836 DOI: 10.1007/s00264-013-2055-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary bone lymphoma is a rare disease. Little is reported about surgical procedures in these patients. We evaluated a single-centre consecutive series of 21 patients for results, prognostic factors and surgical treatment. METHODS Patient ages ranged from 19 to 82 years. The most frequently affected site was the spine (six cases), followed by the ileum, femur and mandible (three cases each). Four patients were treated with chemotherapy and 17 with chemotherapy and radiation therapy. Six patients were affected by a pathological fracture. Surgery was performed in four patients (19%), in two cases before chemotherapy, in one case during chemotherapy and in one case after chemotherapy and radiotherapy. Five patients died within the range of three to 36 months after diagnosis. Average follow-up of the remaining patients was 62.8 (19-145) months. RESULTS Overall survival was 74.2% at five years. The only positive prognostic factor was complete remission after chemotherapy. A trend for better survival was present for International Prognostic Index (IPI) score (P = 0.051), under 40 years of age (P = 0.10) and abnormal lactate dehydrogenase (LDH) values (P = 0.10), but it did not reach statistical significance. CONCLUSIONS Surgical treatment should be aimed at restoring function and eliminating pain while minimising delays in the chemotherapy schedule. When feasible, postponing surgery until after chemotherapy is advisable.
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Affiliation(s)
- Guido Scoccianti
- Orthopaedic Oncology Department, Careggi University Hospital, Largo Palagi 1, Firenze, Italy,
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Kishan Prasad HL, Jayaprakash Shetty K, Mathias L, Sunil Kumar Y, Permi HS, Rao C. Primary Bone Lymphoma of Humerus Diagnosed by FNAC- A Rare Case Report. Indian J Surg Oncol 2013; 4:316-9. [PMID: 24426747 DOI: 10.1007/s13193-013-0251-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 05/31/2013] [Indexed: 11/24/2022] Open
Affiliation(s)
- H L Kishan Prasad
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India ; Department of Orthopaedics, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India
| | - K Jayaprakash Shetty
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India ; Department of Orthopaedics, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India
| | - Lawrence Mathias
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India ; Department of Orthopaedics, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India
| | - Y Sunil Kumar
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India ; Department of Orthopaedics, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India
| | - Harish S Permi
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India ; Department of Orthopaedics, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India
| | - Chandrika Rao
- Department of Pathology, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India ; Department of Orthopaedics, K S Hegde Medical Academy of Nitte University, Deralakatte, Mangalore India
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Ko MJ, Hwang SN, Park YS, Nam TK. Primary malignant lymphoma of the cranial vault with extra- and intracranial extension. Brain Tumor Res Treat 2013; 1:32-5. [PMID: 24904887 PMCID: PMC4027115 DOI: 10.14791/btrt.2013.1.1.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 03/30/2013] [Accepted: 04/03/2013] [Indexed: 11/30/2022] Open
Abstract
Bone involvement is a common finding in many types of lymphomas, particularly in advanced stages. However, cranial vault affliction has been regarded as an exceedingly rare presentation. Here, we report the case of a patient with cranial vault lymphoma who presented with a scalp mass. An 81-year-old woman presented with a gradually growing and non-painful frontal scalp mass that she noticed one month before admission. It was a flatly elevated, round mass measuring about 6×4×4 cm. Computed tomography and magnetic resonance imaging of the brain revealed a contrast-enhancing intracranial extradural mass at the counter-location of the scalp mass. The superior sagittal sinus was involved at the tumor site. Cerebral angiography showed that the tumor feeding vessels originated from the bilateral external carotid arteries. An operation was performed and the tumors were removed together with the involved bone. The pathologic diagnosis was malignant diffuse large B-cell type lymphoma. The patient was transferred to the Hemato-Oncology department for chemotherapy. Primary lymphoma of the cranial vault with scalp mass is very rare but it should be considered in the differential diagnosis of scalp masses. Although the results of reported cases are variable, the combination of surgery, radiation, and chemotherapy appears to offer favorable outcomes.
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Affiliation(s)
- Myeong-Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sung-Nam Hwang
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Yong-Sook Park
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Teak Kyun Nam
- Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea
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41
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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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42
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Barley K, Harris JA, Diefenbach C, Jagannath S, Chari A. Misdiagnosis of non-hodgkin lymphoma as multiple myeloma. J Clin Oncol 2012; 30:e364-7. [PMID: 23109698 DOI: 10.1200/jco.2012.43.0504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kevin Barley
- Mount Sinai School of Medicine, New York, NY 10029, USA
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43
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Giardino AA, Shinagare AB, Shinagare SA, Dewar R, Weckstein D, Mauch P, Ramaiya NH, Freedman AS. Primary bone lymphoma involving bilateral tibia. Am J Hematol 2012; 87:924-5. [PMID: 22641233 DOI: 10.1002/ajh.23245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Angela A Giardino
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA
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44
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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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45
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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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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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47
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Yabe H, Ueno H, Ochi K, Morioka H, Yabe H, Terai C. Possible clinical significance of serum soluble interleukin-2 receptor level in primary bone lymphoma: two case reports. Case Rep Oncol 2011; 4:125-31. [PMID: 21475602 PMCID: PMC3072191 DOI: 10.1159/000325399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In two patients with primary bone lymphoma (PBL) treated in our clinic, serum levels of soluble interleukin-2 receptor (sIL-2R) reflected the clinical course. In both cases, sIL-2R levels were high before treatment and normalized with the therapeutic effects of chemotherapy, coinciding with the changes in lactate dehydrogenase levels and radiographic findings. Adding to the recently reported results of the diagnostic ability of sIL-2R in PBL, our case study highlights the clinical significance of serum sIL-2R levels as a tumor marker in PBL cases.
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Affiliation(s)
- Hiroki Yabe
- Division of Rheumatology, Jichi Medical University Saitama Medical Center, Saitamao, Japan
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48
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Primary bone lymphoma: polyostotic disease presenting as a cauda equina syndrome. J Clin Rheumatol 2010; 16:392-4. [PMID: 21085013 DOI: 10.1097/rhu.0b013e3182005370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a patient with B-cell primary bone lymphoma with involvement of multiple vertebrae at presentation and rapid development of cauda equina syndrome. The patient presented subacute low-back pain, initially with good response to corticosteroid treatment.Primary bone lymphoma is a very unusual disease, commonly affecting only 1 vertebra. Despite this, our case involved multiple levels at the onset; furthermore, there were no adenopathies. Because of the information of the magnetic resonance imaging, an open biopsy of the vertebrae was performed for diagnosis. The reported cases of radicular syndromes secondary to a lymphoma as an initial symptom are extremely infrequently reported in the literature, above all for a B-cell lymphoma.
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49
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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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50
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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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