Surgical site spread of skeletal diffuse large B-cell lymphoma

Challenges of interpreting the musculoskeletal manifestation of lymphoma: A case report

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.

Primary bone lymphoma of radius and tibia: A case report and review of literature

RATIONALE

Primary bone lymphoma (PBL) is a rare malignant entity. There is a better survival of PBL than any other malignant bone tumors and extranodal lymphomas.

PATIENT CONCERNS

We report a rare case of PBL involving radius and tibia. The patient was a 14-year-old girl with left forearm pain and swelling after trauma. Six months later after the last chemotherapy and radiotherapy, pain and swelling of left knee was presented.

DIAGNOSES

Radiological imaging revealed a lytic destruction, periosteal reaction, and pathological fracture of radius and tibia with soft tissue mass. Surgical biopsy was performed, and the result of histopathological diagnosis was diffused large B-cell lymphoma (stage IV, group A).

INTERVENTION

Chemotherapy combined with radiotherapy was applied before curation.

LESSONS

Due to its uncommon presentation, PBL should be taken into consideration if differential diagnosis from other bone tumors is necessary in clinic.

Myeloma in scar tissue--an underreported phenomenon or an emerging entity in the novel agents' era? A single center series

Tumor relapse in scar tissue is uncommon in cancer patients. Likewise, extramedullary plasmacytoma (EMP) relapse in scar tissue in the setting of multiple myeloma (MM) has been rarely reported. We report a series of 3 patients whose disease progressed as EMP at the site of a wound from previous invasive procedures. All 3 patients were treated for the relapsed disease with different treatment modalities, but failed to respond adequately and died several months after relapse. At original MM diagnosis, all had advanced-stage disease. They were treated with novel agents with or without autologous hematopoietic stem cell transplantation and achieved either a complete or very good partial response. We suggest that these treatments, which have become the standard of care in MM, may permit a predominance of myeloma subclones which are independent of the bone marrow microenvironment. These myeloma subclones then gain a survival advantage in the active scar-tissue niche, allowing for their uncontrolled proliferation. This case series might represent an underreported phenomenon and therefore may indicate an emerging and difficult-to-treat disease in the era of targeted therapies in MM. Physicians treating MM should be aware of this phenomenon, especially when referring their patients for invasive procedures.