Lymphoma of Bone
lymphoma of bone, known in the past as reticulum cell sarcoma, is an uncommon
malignancy that accounts for less than 5% of primary malignant bone tumors.
Over 20% of patients with lymphoma have secondary bone involvement
Most intraosseous lesions are non-Hodgkin's
lymphoma. Non-Hodgkin's lymphoma of bone is found in the femur and pelvis
in patients twenty years of age and older. It may present as local pain
or swelling. Primary Hodgkin's lymphoma of bone is exceedingly rare and
may occur anywhere in the skeleton. Patients generally feel they are in
good health otherwise.
Lymphoma of bone has a variable picture on plain-xray.
A lesion may appear as a vague, mottled lucency. This intraosseous lesion
usually has permeative pattern of lysis but may appear blastic or sclerotic.
Periosteal reaction and cortical destruction follow. Plain radiographs
often underestimate the extent of the lesion. CT scan is useful for disease
staging and delineating spinal lesions. MRI is helpful in demonstrating
bone marrow and soft tissue involvement. Lymphoma has an increased uptake
on bone scan. The radiologic differential includes osteosarcoma, Ewing's
sarcoma and osteomyelitis. The possibility of metastatic disease needs
to be eliminated.
On gross examination. primary non-Hodgkin's lymphoma
of bone is a gray-white tumor that diffusely infiltrates bone.
Pathological diagnosis requires clinical suspicion
of lymphoma for good tissue handling. It is essential to get tissue without
crush artifact or decalcification to preserve cell morphology. Needle
biopsy is not adequate. Non-Hodgkin's lymphoma appears most commonly with
large cells with irregular
cleaved nuclei and prominent nucleoli surrounded by reticulin fibers.
The most common subtype is diffuse histiocytic lymphoma. Hodgkin's lymphoma
has a mixed cell population with plasma cells, lymphocytes, histiocytes
and eosinophils. Reed-Sternberg cells are large, sharply delineated cells
with abundant cytoplasm and a double nucleus that make the diagnosis of
Hodgkin's lymphoma. The pathologic differential includes Ewing's sarcoma,
chronic osteomyelitis and eosinophilic granuloma.
Treatment of lymphoma of bone is usually radiation
and chemotherapy. Clinical staging studies include chest x-ray, bone scan,
CBC, serum chemistries, bone marrow aspirate and biopsy. Surgery is only
indicated for pathologic fractures. Lymphoma of bone has the best prognosis
of all primary malignant bone tumors.
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of 25 Cases Reported Over 10 Years, Journal of Surgical Oncology,46:265-269,
Huvos, Andrew, Bone Tumors: Diagnosis. Treatment and Prognosis,
W.B. Saunders, Co., 1991.
Le vis, SJ et al., Malignant Lymphoma of Bone, Canadian Journal
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