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The great mimicker at thoracolumbar spine: Non-Hodgkin's lymphoma. Int J Surg Case Rep 2017; 39:267-270. [PMID: 28881335 PMCID: PMC5587896 DOI: 10.1016/j.ijscr.2017.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 11/21/2022] Open
Abstract
Non-Hodgkin’s lymphoma’s vertebral involvement is quite common. Diagnosis of the non-Hodgkin’s lymphomas that are localized in thoracolumbar spine often is missed or is delayed. It was purposed to report two cases with non-Hodgkin’s lymphoma in thoracolumbar spine with different presentation.
Purpose To report two cases with Non-Hodgkin’s Lymphoma (NHL) in thoracolumbar spine with very different presentation. Methods Case 1; An 84-year-old female patient was admitted to our emergency clinic with paraparesis in both lower extremities. Magnetic resonance imaging (MRI) revealed an epidural mass at the level of the T12 vertebrae. She was operated immediately with wide laminectomy and posterior instrumentation because of the paraparesis of both lower extremities. Case 2; An 70-year-old female patient was admitted to our clinic with thoracolumbar back pain. There was a T12 vertebra compression fracture view in the X-ray imaging. MRI revealed multiple infiltrations in medullar canale at thoracolumbar spine with lytic lesion. She underwent eight cycles of chemotherapy. Results Multiple bone involvement was detected in both cases in PET-CT (Positron emission tomography–computed tomography) scans. Additionally it was found that there were nodal involvements accompanying these involvements in case 1. Because radiological examinations were not spesific enough to diagnose, it was necessary to perform a biopsy. The histopathological diagnosis of these patients revealed diffuse large B cell non-Hodgkin’s lymphoma. Conclusions Diagnosis of the non-Hodgkin’s lymphomas that are localized in thoracolumbar spine is often missed or delayed due to lack of specific findings and presence similarities to other diseases. Diagnosis is made by histopathologic examination. Although the main treatment is chemotherapy for these patients, surgery is necessary for patients with neurological deficite.
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2
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Kornder J, Platt SR, Eagleson J, Kent M, Holmes SP. IMAGING DIAGNOSIS-VERTEBRAL POLYOSTOTIC LYMPHOMA IN A GERIATRIC DOG. Vet Radiol Ultrasound 2015; 57:E42-5. [PMID: 26592800 DOI: 10.1111/vru.12312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/17/2015] [Indexed: 11/28/2022] Open
Abstract
A 9-year-old spayed female Scottish terrier presented with an 8-day history of progressive paraparesis. Neurological examination suggested a painful T3-L3 myelopathy. Multifocal uniform contrast-enhancing masses involving the vertebral bodies, pedicles, laminae, and spinous processes of two vertebrae and compressing the spinal cord were present on MRI. Fluoroscopic-guided fine needle aspiration of one of the vertebral lesions revealed a predominantly lymphoblastic population of cells compatible with a diagnosis of lymphoma. To the authors' knowledge, this represents the first published case of canine lymphoma with vertebral involvement, characterized with MRI.
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Affiliation(s)
- Julie Kornder
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Simon R Platt
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Joe Eagleson
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Marc Kent
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
| | - Shannon P Holmes
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602
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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: 73] [Impact Index Per Article: 8.1] [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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Jacobs AJ, Michels R, Stein J, Levin AS. Socioeconomic and demographic factors contributing to outcomes in patients with primary lymphoma of bone. J Bone Oncol 2014; 4:32-6. [PMID: 26579482 PMCID: PMC4620968 DOI: 10.1016/j.jbo.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/27/2014] [Indexed: 11/29/2022] Open
Abstract
Background Primary lymphoma of bone (PLB) is a rare disease, comprising a malignant lymphoid infiltrate of bone. The goal of this study was to identify socioeconomic, demographic, and anatomic factors as prognostic indicators of survival for this disease using the Surveillance, Epidemiology, and End Results (SEER) database. Methods The SEER database was used to identify a study population of 692 patients diagnosed with PLB in the United States from 1989 to 2003. Survival was analyzed using the Kaplan–Meier method, with effects of potential prognostic factors on survival analyzed using the log-rank test. Multivariable analysis was performed by Cox proportional hazards regression. Results The overall 5-year survival rate was 49.6%, with a 10-year survival rate of 30.2%. Median overall survival was 4.9 years (95% CI: 3.9, 6.1). In multivariable analysis, age (p<0.0001), marital status (p=0.006), and appendicular vs. axial tumor location (p=0.004) were found to be independent predictors of survival. Conclusions This population-based study of PLB identified age, marital status, and tumor location as independent indicators of prognosis. This finding supports the clinical suspicion that an appendicular tumor location confers a better prognosis than an axial tumor location.
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Affiliation(s)
- Andrew J Jacobs
- Hofstra North Shore-LIJ School of Medicine, 500 Hofstra University, Hempstead, NY 11549, USA
| | - Ryan Michels
- Department of Orthopaedics, North Shore Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - Joanna Stein
- Biostatistics Unit, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Adam S Levin
- Department of Orthopaedics, North Shore Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
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Wirth A. Indolent lymphomas occurring in bone. Leuk Lymphoma 2014; 55:1701-2. [DOI: 10.3109/10428194.2013.876635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zhou HY, Gao F, Bu B, Fu Z, Sun XJ, Huang CS, Zhou DG, Zhang S, Xiao J. Primary bone lymphoma: A case report and review of the literature. Oncol Lett 2014; 8:1551-1556. [PMID: 25202366 PMCID: PMC4156201 DOI: 10.3892/ol.2014.2327] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 06/12/2014] [Indexed: 01/29/2023] Open
Abstract
Primary lymphoma of the bone (PLB) primarily arising from the medullary cavity is an extremely rare entity, with only retrospective studies and sporadic cases reported in the literature. The current study presents one case of PLB treated with chemotherapy and radiotherapy, and a review of the literature to elucidate the optimal treatment of PLB. A 73-year-old female presented with pain in the left hip that had persisted for two months. Plain X-ray and magnetic resonance imaging of the left hip showed lytic areas involving the left innominatum. Technetium-99m radionuclide imaging showed increased tracer uptake in the ilium, acetabulum and ischium. An 18F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) scan showed high FDG uptake. A fine-needle aspiration biopsy of the lesion was performed, and histopathological and immunohistochemical examination confirmed a diagnosis of B-cell lymphoma. The patient received radiation therapy followed by six cycles of CHOP regimen (1,000 mg cyclophosphamide, 80 mg epirubicine and 2 mg vincristine on day one, and 100 mg prednisone on days one to five, every three weeks) and achieved a complete response, as confirmed by FDG-PET-CT. At present, the patient is in a good condition. This case is noteworthy, as it is a well-documented case in which the patient received successful treatment. This case demonstrates that PLB has an improved prognosis compared with primary lymphoma of other sites; however, combined therapy may further improve the patient outcome.
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Affiliation(s)
- Hai-Yan Zhou
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Fang Gao
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Bing Bu
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Zheng Fu
- Positron Emission Tomography-Computed Tomography Center, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Xu-Jie Sun
- Department of Pathology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Cheng-Suo Huang
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Deng-Guang Zhou
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Shu Zhang
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
| | - Jun Xiao
- Internal Depatment of Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong 250117, P.R. China
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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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Mohamed M, Brain T, Sharma S. Multifocal primary bone lymphoma: durable complete remission after R-CHOP chemotherapy. BMJ Case Rep 2013; 2013:bcr-2013-009809. [PMID: 23704456 DOI: 10.1136/bcr-2013-009809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary bone lymphoma (PBL) is a type of non-Hodgkin's lymphoma predominantly affecting the skeletal system. PBL is an extremely rare cancer in adults affecting mainly the axial skeleton. The extent of bone involvement in these patients is variable. Most of the cases reported had single or a few skeletal lesions. We report a patient who had extensive multifocal lymphoma involving the axial skeleton and a very good and durable response to R-CHOP chemotherapy.
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Affiliation(s)
- Muhajir Mohamed
- Department of Haematology, Launceston General Hospital, Launceston, Tasmania, Australia.
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10
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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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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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12
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Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer 2010; 116:871-9. [PMID: 20043324 DOI: 10.1002/cncr.24828] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Muhammad U Jawad
- Department of Orthopedics, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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13
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Staub-Zähner T, Garzoni D, Fretz C, Lampert C, Ohlschlegel C, Wüthrich RP, Fehr T. Pseudotumor of gout in the patella of a kidney transplant recipient. ACTA ACUST UNITED AC 2007; 3:345-9. [PMID: 17525717 DOI: 10.1038/ncpneph0494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 02/07/2007] [Indexed: 11/10/2022]
Abstract
BACKGROUND A 33-year-old renal transplant recipient presented with painless swelling of the right knee. Physical examination revealed an impressive knee joint effusion with no signs of inflammation. The patient did not remember a recent trauma, but he mentioned a strain 3 years earlier; radiographic findings had been normal at that time. The patient had suffered from end-stage renal disease due to chronic glomerulonephritis and had previously undergone two transplantations. At presentation, his kidney function was stable under treatment with ciclosporin, azathioprine and steroids. INVESTIGATIONS Conventional radiography revealed a tumor at the superolateral pole of the right patella. Extensive soft tissue invasion and bone destruction was seen on MRI. A knee arthroscopy with biopsy, performed to aid diagnosis, showed extensive chondrocalcinosis macroscopically; histologically, gouty tophi were found. DIAGNOSIS Pseudotumor of gout in the patella. MANAGEMENT Uric-acid-lowering therapy with benzbromarone was started immediately after diagnosis. A local arthroscopic debridement of the right knee joint was performed 4 months later, and the patient remained asymptomatic for the next 3 years.
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Lewis VO, Primus G, Anastasi J, Doherty D, Montag AG, Peabody TD, Simon MA. Oncologic outcomes of primary lymphoma of bone in adults. Clin Orthop Relat Res 2003:90-7. [PMID: 14612634 DOI: 10.1097/01.blo.0000093901.12372.ad] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A retrospective analysis of adult patients who had lymphomatous involvement of bone was done to evaluate the prognostic factors and the oncologic outcome. Between 1984 and 1994, 28 patients (nine women and 19 men) were diagnosed with lymphoma of bone. The median age was 45 years (range, 23-76 years). The median followup was 40.3 months (range, 0.5 months-15.8 years). Eighteen patients (64%) were classified as having Stage IE disease, two patients (36%) were classified as having stage II disease, and eight patients were classified as having Stage IV disease. Twenty-one of the lesions were classified as diffuse large B cell with multilobulated nuclei. Two patients had local recurrence. Three patients had osteonecrosis develop at the site of their radiation therapy. The 5-year Kaplan-Meier survival estimate was 57.8% (95% confidence interval range, 40-33 82.8). Statistically improved survival was seen in patients younger than 40 years and those patients with diffuse large B cell with multilobulated nuclei. Patients with primary lymphoma of bone did not have a statistically improved survival compared with patients with systemic disease. The results of the current study suggest that age at diagnosis and histologic subtypes are important prognostic factors; however, the diagnosis of primary lymphoma of bone does not confer improved prognosis.
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15
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Gianelli U, Patriarca C, Moro A, Ponzoni M, Giardini R, Massimino M, Alfano RM, Armiraglio E, Nuciforo P, Bosari S, Coggi G, Parafioriti A. Lymphomas of the bone: a pathological and clinical study of 54 cases. Int J Surg Pathol 2002; 10:257-66. [PMID: 12490975 DOI: 10.1177/106689690201000403] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We examined 28 cases of primary bone lymphomas (PBL; stage IE) and 26 cases of systemic lymphomas involving the bone (SBL; stage IIE to IV). Two histologic types were prevalent: Diffuse large B-cell lymphomas (DLBCL; 26 PBL and 21 SBL) and CD30+ anaplastic large cell lymphomas (ALCL; 1 PBL and 4 SBL). A mature B phenotype (CD45+, CD20+, CD79a+, CDw75+/-, CD10-/+) was established in the DLBCL group. Bcl-2 immunoreactivity was demonstrated in 13/37 cases (35%), and bcl-6 immunostaining was observed in 22/32 cases (69%). ALCL showed null/T phenotype (CD3-/+; CD43+/-; CD30+), with ALK-1 expression in 3/3 cases. With use of a FR3A primer, a monoclonal pattern was demonstrated by PCR analysis in 22/41 lymphomas (54%). Bcl-2 translocation was identified in 2/41 cases (5%). This study details the clinical and pathological characteristics of bone lymphomas. Our immunohistochemical and molecular data suggest that most of them are "de novo" DLBCL and support their follicle center origin.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Animals
- Biomarkers, Tumor/analysis
- Bone Neoplasms/chemistry
- Bone Neoplasms/genetics
- Bone Neoplasms/pathology
- Child
- Clone Cells
- DNA, Neoplasm/analysis
- Female
- Gene Rearrangement
- Genes, bcl-2/genetics
- Humans
- Immunoenzyme Techniques
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large-Cell, Anaplastic/chemistry
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Polymerase Chain Reaction
- Proportional Hazards Models
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Affiliation(s)
- Umberto Gianelli
- Departement of Medicine, Surgery and Dental Sciences, AO S Paolo (HSP), Milan, Italy
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Ebus SCM, Bernsen HJJA, Norel Van GJ, Donk R. Primary non-Hodgkin's lymphoma in multiple vertebrae presenting as a lumbar radicular syndrome: A case report. Spine (Phila Pa 1976) 2002; 27:E271-3. [PMID: 12004189 DOI: 10.1097/00007632-200205150-00025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report is presented. OBJECTIVE To report and discuss a case of primary non-Hodgkin's lymphoma in 10 different vertebrae in the spine of a 25-year-old woman. SUMMARY OF BACKGROUND DATA To the authors' knowledge, a case of primary bone lymphoma in several vertebrae has not been reported previously. METHODS Primary bone lymphoma was diagnosed using magnetic resonance images and biopsy of one spine lesion. There was no other localization of the lymphoma. RESULTS With chemotherapeutic treatment, the lymphoma was in remission for 16 months. The patient then died of complications associated with acute lymphatic B-cell leukemia. CONCLUSIONS The incidence of primary bone lymphoma in a population with non-Hodgkin's lymphoma is less than 1%. A case with multiple localizations of lymphoma in the spine has never been reported before.
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Affiliation(s)
- S C M Ebus
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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17
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Briggs JH, Miller TP. Combined chemotherapy plus radiotherapy for treatment of early-stage intermediate- and high-grade non-Hodgkin's lymphoma. Curr Oncol Rep 2000; 2:176-81. [PMID: 11122841 DOI: 10.1007/s11912-000-0091-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Treatment of localized (stages I, IE, non-bulky II and IIE) aggressive histologies of non-Hodgkin's lymphoma has evolved over the past 20 years. Prior to 1980, these diseases were shown to be locally controlled with radiotherapy, but systemic relapse and death were common. With the discovery of potentially curative doxorubicin- containing chemotherapy, pilot studies during the 1980s demonstrated the utility of combination chemotherapy as initial therapy by increasing the proportion of cured patients. In the 1990s, two large randomized, prospective trials set the benchmark for future comparisons by establishing initial chemotherapy followed by radiation therapy (combined modality therapy) as the best available current treatment strategy.
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Affiliation(s)
- J H Briggs
- Departments of Radiation Oncology and Medicine, Arizona Cancer Center, University of Arizona, 1515 North Campbell Avenue, Tucson, AZ 85724, USA
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18
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Affiliation(s)
- C R Pinkerton
- Department of Paediatric Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey
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19
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Zucca E, Roggero E, Bertoni F, Conconi A, Cavalli F. Primary extranodal non-Hodgkin's lymphomas. Part 2: Head and neck, central nervous system and other less common sites. Ann Oncol 1999; 10:1023-33. [PMID: 10572599 DOI: 10.1023/a:1008313229892] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- E Zucca
- Istituto Oncologico della Svizzera Italiana, Divisione di Oncologia Medica, Ospedale San Giovanni Bellinzona, Switzerland.
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20
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Leonard JP, Coleman M. Primary non-Hodgkin's lymphoma of bone. Cancer Invest 1998; 16:616-7. [PMID: 9844623 DOI: 10.3109/07357909809032893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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