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Barbon DA, Williams TP, Hulse HB, Hansford BG. Primary lymphoma of bone of the little finger: a case report and review of the literature. Skeletal Radiol 2024; 53:1645-1650. [PMID: 38225403 DOI: 10.1007/s00256-024-04576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
Primary lymphoma of bone (PLB) is a rare, malignant lymphoid proliferation within bone accounting for less than 3% of all malignant bone tumors. In this case report, a 61-year-old female with past medical history of gout presented with pain and swelling in her right little finger. Initial radiographs demonstrated periostitis and soft tissue swelling about the right little finger. She returned three months later with progressive pain. Subsequent MRI and repeat radiographs demonstrated near complete destruction of the right little finger middle phalanx and periostitis with marrow infiltration at the right long finger. Given the rapid progression of disease, the differential diagnosis consisted primarily of aggressive neoplastic processes. The little finger ray was amputated through the level of the metacarpophalangeal joint and histopathology demonstrated large neoplastic cells that stained positive with CD45, CD20, and PAX5, compatible with diffuse large B-cell lymphoma. A subsequent normal bone marrow aspiration and PET-CT demonstrated no additional sites of disease, thus excluding secondary lymphoma to bone. To the best of our knowledge, this is the first case report of polyostotic PLB involving the hand. PLB of the hands may be initially misdiagnosed due to its rarity and clinical presentation mimicking rheumatological disease. Clinical vigilance in concert with close imaging follow-up is required to make the diagnosis in a timely fashion. We also review the existing PLB hand literature which consists of five cases.
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Affiliation(s)
- Dennis A Barbon
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA.
| | - Todd P Williams
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Hailey B Hulse
- College of Medicine, University of Illinois Chicago, Portland, IL, USA
| | - Barry G Hansford
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA
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2
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Elawad MF, Sibira DM, Ammar A, Szabados L, Ibrahem RE. Synchronous gnathic osteosarcoma and B-cell lymphoblastic lymphoma/leukemia: A rare case presentation. Radiol Case Rep 2023; 18:4085-4090. [PMID: 37705886 PMCID: PMC10495600 DOI: 10.1016/j.radcr.2023.08.028] [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: 03/25/2023] [Revised: 06/28/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Multiple primary malignancies are a well-recognized entity, with increased recognition and detection alongside development of hybrid imagining. We present a rare case of a 16-year-old male with gnathic osteosarcoma and incidental finding of a second silent synchronous B-cell lymphoblastic lymphoma/leukemia in the lower limb. Treated successfully by chemotherapy, radiotherapy, and surgery.
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Affiliation(s)
| | | | - Adham Ammar
- Laboratory Department, Hamad General Hospital, PO 3050, Doha, Qatar
| | - Lajos Szabados
- Nuclear Medicine, Hamad General Hospital, PO 3050, Doha, Qatar
| | - Renan E. Ibrahem
- CMED-Qatar University, Hamad General Hospital, PO 3050, Doha, Qatar
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3
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Padwal J, Baratto L, Chakraborty A, Hawk K, Spunt S, Avedian R, Daldrup-Link HE. PET/MR of pediatric bone tumors: what the radiologist needs to know. Skeletal Radiol 2023; 52:315-328. [PMID: 35804163 PMCID: PMC9826799 DOI: 10.1007/s00256-022-04113-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/11/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
Integrated 2-deoxy-2-[fluorine-18]fluoro-D-glucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) imaging can provide "one stop" local tumor and whole-body staging in one session, thereby streamlining imaging evaluations and avoiding duplicate anesthesia in young children. 18F-FDG PET/MR scans have the benefit of lower radiation, superior soft tissue contrast, and increased patient convenience compared to 18F-FDG PET/computerized tomography scans. This article reviews the 18F-FDG PET/MR imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors, including osteosarcoma, Ewing sarcoma, primary bone lymphoma, bone and bone marrow metastases, and Langerhans cell histiocytosis.
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Affiliation(s)
- Jennifer Padwal
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Lucia Baratto
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Amit Chakraborty
- Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Kristina Hawk
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sheri Spunt
- Department of Pediatrics, Stanford University, 725 Welch Rd., Rm. 1665, Stanford, CA, 94305-5614, USA
| | - Raffi Avedian
- Department of Surgery, Division of Pediatric Orthopedic Surgery, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94305, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
- Cancer Imaging Program, Stanford Cancer Institute, Stanford, USA.
- Department of Pediatrics, Stanford University, 725 Welch Rd., Rm. 1665, Stanford, CA, 94305-5614, USA.
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4
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Mufti MA, Matthews R, Madu E, Yaddanapudi K, Franceschi D. “Low Dose MR” Dixon Technique for Imaging FDG PET-MR Lymphoma. World J Nucl Med 2022; 21:99-105. [PMID: 35865157 PMCID: PMC9296239 DOI: 10.1055/s-0042-1750330] [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] [Indexed: 12/03/2022] Open
Abstract
Introduction
Hybrid PET-MR is a relatively new imaging modality with its major strength being the MR component offering superior soft tissue contrast. While PET/MRI offers the inherent advantage of reduced radiation dose, it has been shown to result in a markedly prolonged examination time becoming a challenge in children and sick patients. "Low dose MRI" is a term used in the nuclear medicine community to describe fast acquired PET-MR scan protocols that rely heavily on PET images for diagnosis. In this study, we sought to determine if the Dixon sequences obtained for attenuation correction could be used as a diagnostic sequence for interpreting PET-MRI lymphoma cases, potentially reducing scan time.
Materials and Methods
We retrospectively identified 40 patients who underwent
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FDG PET-MR body imaging studies for staging or restaging lymphoma. A radiologist and nuclear medicine physician initially reviewed top of the head to mid thigh PET images, attenuation correction coronal Dixon MRI sequences, and PET-MR fusion with Dixon sequence. The same physicians reviewed the PET images, multi-sequence MR including the attenuation correction Dixon, and multi-sequence PET-MR fusion images The lesions were further characterized based on their imaging characteristics, size, SUVmax, and malignant potency. A consensus read followed.
Results
All patients were adults with an average study age of 43.8 years. Our study consisted of 40 females and 48 males out of which 7 were for staging and 81 were for re-staging. All patients had systemic lymphoma. Thirty-seven of the studies had active lymph nodes on Dixon PET-MR that agreed with multi-sequence PET-MR which identified 33 positive cases (89.1%) having an average SUV 10.2 ± 7.74 SD. Four Dixon PET-MR cases did not detect lesions, with an average SUV 2.3 ± 0.55 SD, which was read as minimal residual activity. Multi-sequence MR identified 11 patients with enlarged lymph nodes without FDG uptake, which were not seen on Dixon MR. All 5 studies with bones lesions were detected by Dixon PET-MR as well as 2 soft tissue organ lesions. Multi-sequence MR identified 1 patient with non-active, healed bone lesion. Fifty-five of these studies were true negatives. Compared to multi-sequence PET-MR, Dixon PET-MR demonstrated 89.2% sensitivity, 100% specificity with no false positive studies.
Conclusion
The present study investigated the diagnostic potential of a fast protocol for integrated PET/MRI used for dedicated tumor staging of patients with lymphoma. In this retrospective study, Dixon PET-MR was shown to be sensitive and specific compared to multi-sequence PET-MR in the detection of lymphoma. The low number of these cases not detected had minimally active lymph nodes that resolved on subsequent imaging and probably were not clinically important.
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Affiliation(s)
- Musa Ali Mufti
- Department of Radiology, Stonybrook University Hospital, New York, New York, United States
| | - Robert Matthews
- Department of Nuclear Medicine, Stony Brook University Hospital, New York, New York, United States
| | - Ezemonye Madu
- School of Medicine, Hofstra/Northwell, New York, New York, United States
| | - Kavitha Yaddanapudi
- Department of Medical Imaging, College of Medicine, Tucson, Arizona, United States
| | - Dinko Franceschi
- Department of Nuclear Medicine, Stony Brook University Hospital, New York, New York, United States
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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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Catania R, Belloni E, Preda L, Bortolotto C, Scagnelli P, Calliada F. Odontogenic-Like Pain in Partial Edentulism: An Unusual Presentation of Diffuse Large B-Cell Lymphoma of the Mandible. Indian J Radiol Imaging 2022; 31:1053-1056. [PMID: 35136528 PMCID: PMC8817793 DOI: 10.1055/s-0041-1741552] [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] [Indexed: 11/23/2022] Open
Abstract
Primary bone lymphoma is a rare entity and it usually occurs in long bones. Primary mandibular involvement is very rare, and it usually shows unspecific features, mimicking odontogenic inflammatory lesions. We present the unusual case of a diffuse large B-cell lymphoma (DLBCL) of the right mandibular body in a 91-year-old woman, who presented with acute pain in the mandibular region initially suspicious for odontogenic abscess. No significant findings were seen on orthopantomography (OPG) and her almost complete edentulism made the diagnosis of abscess unlikely. Computed tomography and magnetic resonance images showed an expansive mass around the right mandibular body with erosion of cortical bone and involving the right mandibular canal and nerve. Final diagnosis of DLBCL was pathologically proven. The presence of odontogenic-like pain in nearly complete edentulism should be suspicious for malignancy, and it needs further diagnostic workup despite the absence of signs on OPG.
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Affiliation(s)
- Roberta Catania
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Belloni
- Department of Radiology, Civil Hospital, Vigevano, Italy
| | - Lorenzo Preda
- Diagnostic Imaging Unit, National Centre of Oncological Hadrontherapy, Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Scagnelli
- Department of Radiology, Ospedale Maggiore di Lodi, Lodi, Italy
| | - Fabrizio Calliada
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Cao X, Chen HJ. Successful Outcome of Patellectomy Plus Chemotherapy for Primary Bone Lymphoma of the Patella: A Case Report and Literature Review. Front Oncol 2021; 11:786495. [PMID: 34966686 PMCID: PMC8710498 DOI: 10.3389/fonc.2021.786495] [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] [Received: 09/30/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Primary bone lymphoma (PBL) is a rare but distinct clinicopathological disease, usually occurring in the pelvis, spine, and ribs. To date, only a few cases have been reported as beginning in the patella. Due to the lack of clinical evidence, the optimal treatment strategy has not been established. Here, we report a case that presented unexplained right knee pain. The case was diagnosed with the non-germinal center, diffuse large B cell lymphoma in the patella by imaging examinations and bone biopsy. Then, the patient received a patellectomy and eight cycles of R-CHOP chemotherapy. After treatment, the patient achieved a favorable prognosis and satisfactory functional recovery.
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Affiliation(s)
- Xin Cao
- Department of Traumatic Orthopedics, Shengli Oilfield Central Hospital, Dongying, China
| | - Hui-Jin Chen
- Department of Clinical Laboratory, Shengli Oilfield Central Hospital, Dongying, China
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8
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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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9
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Batia T, Yassin MA, Mudawi DS, Hamid OA, Abdalhadi AMA. Primary Bone Lymphoma in Axial Skeleton in a Middle-Aged Female Presented as Recurrent Anemia. Case Rep Oncol 2020; 13:276-280. [PMID: 32308590 PMCID: PMC7154249 DOI: 10.1159/000506362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
Primary bone lymphoma (PBL) is a peculiar extranodal presentation of non-Hodgkin's lymphoma. Primary bone diffuse large B-cell lymphoma (DLBCL) is the most common pathological type, comprising about 80% of PBL. The diagnosis of PBL depends on the combined clinical examination and imaging studies and is confirmed with immunohistochemical examination. Due to the rarity of this disease, more relative studies and case reports are needed to provide insight into this obscure lymphoproliferative malignancy. Here, we report one rare case of primary bone DLBCL involving the axial skeleton in a 37-year-old female.
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10
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Surgical Management of Primary Bone Lymphoma of the Hip: A Case Report and Review of the Literature. Case Rep Orthop 2019; 2019:3174768. [PMID: 30944745 PMCID: PMC6421802 DOI: 10.1155/2019/3174768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/19/2019] [Accepted: 02/03/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Primary bone lymphoma (PBL) is a rare bone malignancy which may present with atraumatic pain, swelling, or pathological fracture. Whilst the femur is the most commonly affected site, any bone may be involved. PBL should be distinguished from other bone lesions to determine clinical management. Case Report We report the case of an 89-year-old gentleman who presented to the local emergency department with atraumatic hip pain and inability to weight-bear. Multimodal imaging showed evidence of a tumor involving the proximal femur and adjacent acetabulum with an associated pathological intertrochanteric fracture. Biopsy specimens demonstrated this to be PBL of the diffuse large B-cell subtype. No other disease foci or nodal involvement was identified. The patient underwent proximal femoral replacement and acetabular reconstruction prior to commencing R-Mini-CHOP chemotherapy, during which time he has been permitted to fully weight-bear. Conclusion To our knowledge, this is the first reported case of a patient having PBL with both femoral and acetabular involvements. Due to its infrequent occurrence, evidence remains limited to advise therapeutic guidelines. Our practice concurs with literature suggesting that surgery be reserved for cases of pathological fracture. However, the merits of undergoing surgical fixation prior to chemoradiation treatment have been considered.
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11
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Primary Bone Marrow B-Cell Lymphoma Undetected by Multiple Imaging Modalities That Initially Presented with Hypercalcemia. Case Rep Endocrinol 2018; 2018:7676580. [PMID: 30147967 PMCID: PMC6083738 DOI: 10.1155/2018/7676580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose We report a rare case of severe hypercalcemia that was ultimately diagnosed as primary bone marrow diffuse large B-cell lymphoma (BCL). Case Report A 74-year-old male patient visited our hospital complaining of tenderness and swelling of the left knee caused by supracondylar fracture of the left distal femur. His initial blood tests showed a serum calcium level of 13.9 mg/dL, inorganic phosphorus of 4.34 mg/dL, and a serum creatinine level of 1.54 mg/dL. A serum assay of intact parathyroid hormone showed 5.24 pg/mL, and the patient's serum 25(OH)D level was 22.33 ng/mL. To exclude malignancy, we performed imaging studies, including abdomen or chest computed tomography and positron emission tomography-computed tomography; however, no suspicious lesion was found, although the serum PTH-related peptide level was elevated at 4.0 pmol/L. A bone marrow biopsy was performed to identify any hidden hematologic malignancy. As a result, the pathology of bone marrow confirmed the presence of atypical lymphocytes that stained positive for the CD20 marker, which is consistent with BCL involving the bone marrow. Conclusion This case highlights the importance of pursuing a thorough workup for rare underlying causes of hypercalcemia when parathyroid-related etiologies can be excluded.
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Tsuchiya H. Primary Lymphoma of the Pelvis: A Case Report. J Orthop Case Rep 2018; 7:6-9. [PMID: 29600200 PMCID: PMC5868887 DOI: 10.13107/jocr.2250-0685.924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Primary lymphoma of the bone (PLB) is uncommon clinical entity with the vast majority of the cases are non-Hodgkin’s lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of PLB. Case Report: We report a case of 60-year-old female presented with pain in the right hip that persisted for 2 months. Plain X-ray, computed tomography, and magnetic resonance imaging of the right hip showed a lytic lesion involving the right acetabulum and adjoining iliac bone with extraosseous mass. The histopathological and immunohistochemical examination confirmed a diagnosis of DLBCL. Treatment with cyclophosphamide, epirubicin, vincristine, and prednisone plus rituximabestablished a complete response (CR) with remodeling of the acetabulum. At the last follow-up, the patient had the ability to walk without any support which obviates the need of primary surgical interference for the tumor. Conclusion: The PLB must be considered in the differential diagnosis of lytic lesions involving the pelvic bones in older adults, especially when accompanied by extraosseous soft tissue mass. Our patient of PLB showed goodremodeling of the acetabular area after CR to chemotherapy without primary surgical interference for the tumor with the limitation of weight-bearing during chemotherapy treatment to prevent fracture.
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Affiliation(s)
- Karem M Zekry
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minia, Egypt
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Pelletier-Galarneau M, Martineau P, Lambert R, Turpin S. False Negative 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Primary B-cell Lymphoma of the Bone. World J Nucl Med 2017; 16:166-168. [PMID: 28553187 PMCID: PMC5436326 DOI: 10.4103/1450-1147.203070] [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: 11/13/2022] Open
Abstract
We present a case of a 15-year-old male with primary bone lymphoma who was initially referred for suspicion of chronic osteomyelitis of the mandible. A bone scan and gallium scan demonstrated congruent uptake in the mandible, suggestive of chronic osteomyelitis. A biopsy subsequently showed B-cell lymphoma of the bone with low Ki-67. A fluorodeoxyglucose positron emission tomography (FDG-PET) scan performed before therapy for staging revealed no increased uptake in the mandible. This case shows an atypical presentation of a rare disorder and is presented to emphasize the importance of baseline FDG-PET.
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Affiliation(s)
| | - Patrick Martineau
- Division of Nuclear Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Raymond Lambert
- Department of Nuclear Medicine, Hopital Ste-Justine, Quebec, Canada
| | - Sophie Turpin
- Department of Nuclear Medicine, Hopital Ste-Justine, Quebec, Canada
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15
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Wang J, Fan S, Liu J, Song B. A rare case report of primary bone lymphoma and a brief review of the literature. Onco Targets Ther 2016; 9:4923-8. [PMID: 27563248 PMCID: PMC4984831 DOI: 10.2147/ott.s108000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Primary bone lymphoma is a rare and peculiar extranodal presentation of non-Hodgkin’s lymphoma, which threatens human health. It can be defined as a lymphoma that occurs in the bone, consisting of a single bone lesion with or without regional lymphadenopathies, and its underlying causes are largely unknown. In this case report, we describe a male who presented with left-sided distal forearm pain, swelling of 2 months duration, and progressive limited wrist motion for about 1 month. The patient had no significant medical history except diabetes. Magnetic Resonance Imaging demonstrated a sheet-like bone destruction area in the left-sided radius, localized discontinuous bone cortex, and adjacent soft tissue masses. Finally, a bone biopsy examined by histopathological and immunochemical methods confirmed a diagnosis of primary bone diffuse large B-cell lymphoma. Due to the rarity of this disease, the level of evidence supporting some diagnostic and therapeutic decisions remains low, and therefore, the details of the rare case may facilitate treatment of similar diseases and provide insight about this obscure lymphoproliferative malignancy. Also, related recent literature reports of primary bone lymphoma are reviewed.
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Affiliation(s)
- Jia Wang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences; Department of Oncology, Shandong Cancer Hospital affiliated to Shandong University
| | - Shouren Fan
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences; Department of Intervention, Qihe People's Hospital
| | - Jie Liu
- Department of Oncology, Shandong Cancer Hospital affiliated to Shandong University
| | - Bao Song
- Elementary Laboratory, Shandong Cancer Hospital affiliated to Shandong University, Jinan, People's Republic of 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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Wang LJ, Wu HB, Wang M, Han YJ, Li HS, Zhou WL, Wang QS. Utility of F-18 FDG PET/CT on the evaluation of primary bone lymphoma. Eur J Radiol 2015; 84:2275-9. [PMID: 26388466 DOI: 10.1016/j.ejrad.2015.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Primary bone lymphoma (PBL) is a rare type of malignant lymphoma. Few data have been reported regarding the utility of F-18 FDG PET/CT in this disease. The aim of this study was to assess the role of F-18 FDG PET/CT in the diagnosis and therapeutic effect evaluation of PBL. MATERIALS AND METHODS A total of 19 consecutive patients with PBL were enrolled. Whole-body PET/CT scan was performed for all patients. The diagnosis of PBL was established by histopathology and immunohistochemistry. RESULTS F-18 FDG PET/CT was positive in 94.7% (18/19) of patients. Uptake of FDG in lesions was intense with SUVmax of 15.14 ± 11.82. Multiple involved lesions were found in 47.4% (9/19) patients, while 52.6% presented with a single involved lesion. Based on the lesions, PET detected 98.9% (87/88) lesions. Among them, 71.6% (63/88) lesions were found to be located in axial skeleton and 28.4% (25/88) in the extremity skeleton. FDG PET/CT also found the lesions infiltrate to the surrounding soft tissue in 84.2% (16/19) patients. On the syn-modality CT, the bone destruction was noted in 43.2% (38/88) of the lesions, of which 50.0% lesions presented as slight change in bone density and 50.0% as severe change. The diagnostic sensitivity of PET was much higher than that of CT (98.9% vs. 43.2%, P=0.000). PET/CT was performed for evaluation of treatment response in 13 patients. In 12 patients with complete response(CR), PET/CT found the 25 lesions were F-18 FDG fully resoluted after treatment, however, bone destruction was still presented in 72.0% (18/25) lesions. CONCLUSIONS The present study suggests that F-18 FDG PET/CT was a sensitive imaging modality for diagnosis and treatment response evaluation of PBL.
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Affiliation(s)
- Li-Juan Wang
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Hu-Bing Wu
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Meng Wang
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Yan-Jiang Han
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Hong-Sheng Li
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Wen-Lan Zhou
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
| | - Quan-Shi Wang
- NanFang PET/CT Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China.
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