Learning objectives
To provide a review of imaging findings in Primary Musculoskeletal Lymphoma,
emphasizing on imaging clues that may promote a more specific diagnosis.
Background
Introduction
Primary bone lymphoma (PBL) is an uncommon malignant neoplasm,
usually manifesting as a solitary bone lesion.
PBL mainly involves extranodal non-Hodgkin's lymphoma (NHL),
with B-cell subtype being the most common.
On the contrary,
Hodgkin's PBL is strikingly rare and patients may have concurrent nodal disease detected at staging.
Multifocal subtype of the disease is infrequent.
Primary muscular lymphoma (PML) is also uncustomary.
Clinical features
PBL/PML manifest with non-specific symptoms,
usually subtle intermittent pain.
Other symptoms include soft-tissue edema,
palpable mass,
and rarely “B-symptoms” (almost...
Imaging findings OR Procedure Details
Imaging studies of 14 patients with suspected musculoskeletal lymphoma were retrospectively reviewed.
Two patients presented with palpable mass (PML cases,
Fig.
11,
13-14),
whereas pain was the major symptom in the rest (PBL patients).
PBL was located in the extremities in 5 patients (Fig.
1-2,3-4,7),
the pelvis in 2 patients (Fig.
9-10,12) and the spine in 3 patients (Fig.
5,6,8).
Two patients presented with multifocal PBL (Fig.
6,8).
Associated soft-tissue mass was depicted in four PBL cases (Fig.
8).
X-rays showed a permeative pattern in...
Conclusion
PBL/PML are malignant neoplasms with varied radiographic appearance,
often non-specific.
A high index of suspicion is required to minimize delayed diagnosis and misdiagnosis.
Osseous lymphoma might appear normal or demonstrate subtle findings on radiographs but may have a sonorous appearance on other studies.
Further imaging is necessary to unmask underlying marrow disease.
MRI remains the key imaging technique,
both in the diagnostic and differential-diagnostic procedure.
We should always consider lymphoma when encountering a poorly-defined sclerotic or mixed sclerotic/lytic bone lesion,
demonstrating locally aggressive behavior.
Imaging...
References
[1].
Mra Aye,
Jason Cabot,
Zulkimi Roslly and Chiew Junloong.
Primary Lymphoma of Bone: A case report and brief review of literature.
Clinical Case Reports and Reviews,
2017 (DOI: 10.15761/CCRR.1000346).
[2].
Tarun Kumar Badam,
Sathish Devadoss,
Muthukumar Balaji,
Annamalai Devadoss and Rajasekharan.
Primary Bone Lymphoma – Mimicking as Osteomyelitis: An Unusual Presentation.
Journal of Orthopedic Oncology,
2016; 2:2 (DOI: 10.4172/2472-016X.1000111).
[3].
Kathryn S.
Milks,
Thomas W.
McLean,
Evelyn Y.
Anthony.
Imaging of primary pediatric lymphoma of bone.
Pediatric Radiology,
2016; 46:1150–1157 (DOI: 10.1007/s00247-016-3597-8).
[4].
Jamie...