Hodgkin's Lymphoma of Bone

Bony involvement of Hodgkin’s disease (HD) is between 9.2% - 30.3% of patients. Bone marrow involvement in late stages of HD usually does not produce destructive bone lesions. Primary bone involvement of HD is particularly rare, occurring in less than 1%. Osseous lesions are most commonly due to hematogenous dissemination in stage IV disease or due to direct invasion from an adjacent lymph node leading to focal sclerosis. Primary bone involvement is thought to arise "de novo" within marrow, resulting in cortical erosion and lysis.

Usually pain is the presenting symptom in primary bone disease. Weight loss and malaise may be absent. Lytic lesions are most common, but mixed or sclerotic lesions can also be seen. Lesions may be associated with a periosteal reaction. Bone scintigraphy is useful in detection of skeletal HD. MRI is very sensitive in the localization of subtle marrow disease. Marrow involvement produces a hypointense signal on T1 weighted spin echo sequences and high signal on T2 weighted gradient echo sequences.

Histology is often confusing. Small biopsy specimens are often not diagnostic. Paget’s disease, metastatic tumors, chronic osteomyelitis, eosinophilic granuloma, and primary sarcoma are among the histological differentials.

The prognosis in stage Ie is similar to that of local nodal disease without osseous involvement. Patients with one or multiple bone lesions usually respond well to combined modality treatment, including chemotherapy and local radiotherapy. Surgery should be considered for lesions that present a risk of pathological fracture.


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