Skip to main content

Advertisement

SpringerLink
Log in

MR features of primary bone lymphoma in children

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Primary lymphoma of bone is an uncommon non-Hodgkin lymphoma. Magnetic resonance imaging (MRI) features of primary lymphoma of bone in children are not well described.

Objective

To identify typical MRI characteristics of pediatric primary lymphoma of bone at diagnosis and following treatment.

Materials and methods

Two pediatric radiologists retrospectively reviewed all imaging studies of 10 patients with biopsy-proven primary lymphoma of bone at presentation and after treatment. Anatomic location, number of sites, location within bone (epiphyseal, metaphyseal, diaphyseal), T1-weighted imaging margins, soft tissue mass, T2-weighted imaging appearance and enhancement pattern (homogeneous, heterogeneous, infarct-like), soft tissue edema, cortical disruption, and regional lymph nodes as seen on MRI as well as radiographic and positron emission tomography (PET) findings were recorded. Pathologic results, treatment plans, and outcomes at follow-up as detailed in the medical record were tabulated.

Results

Of 10 patients, age at diagnosis 8–17 years, median 15 years, 4 (40%) had multifocal disease. MRI revealed 20 total lesions in the 10 patients with femoral lesions most common, being present in 7 (70%) of patients. Eight (80%) patients had at least one lesion around the knee. Eight (80%) patients had 1 or more lesions involving an epiphysis and 5 (50%) had at least 1 lesion confined to the epiphysis. Seven (70%) showed infarct-like appearance on T2-weighted imaging; 7 (88%) of the 8 patients with post-contrast imaging had infarct-like enhancement. Six (60%) had sharp T1 margins, 3 (30%) had cortical disruption, 8 (80%) had at least mild soft tissue edema, and 1 (10%) had soft tissue mass. Three (30%) had at least 1 PET-positive regional lymph node. At follow-up (range 1–108 months, median 4.3 months), all had residual osseous abnormality on MRI with 6 (60%) maintaining an infarct-like or combination of infarct-like and T2 hyperintense appearance.

Conclusion

Our results in this series of pediatric primary lymphoma of bone identified several frequent MR imaging features. Multifocality, epiphyseal involvement (especially about the knee), infarct-like enhancement pattern, sharp T1 margins, and surrounding soft tissue edema should raise suspicion for primary lymphoma of bone. Following treatment, residual osseous abnormality is expected on MRI.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author upon request.

References

  1. Bhagavathi S, Fu K (2014) Primary lymphoma of bone: a review. Semin Diagn Pathol 31:48–52

    Article  PubMed  Google Scholar 

  2. Glotzbecker MP, Kersun LS, Choi JK et al (2006) Primary non-Hodgkin’s lymphoma of bone in children. J Bone Joint Surg Am 88:583–94

    PubMed  Google Scholar 

  3. Huebner-Chan D, Fernandes B, Yang G, Lim MS (2001) An immunophenotypic and molecular study of primary large B-cell lymphoma of bone. Mod Pathol 14:1000–7

    Article  CAS  PubMed  Google Scholar 

  4. Demircay E, Hornicek FJ Jr, Mankin HJ, Degroot H 3rd (2013) Malignant lymphoma of bone: a review of 119 patients. Clin Orthop Relat Res 471:2684–90

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lones MA, Perkins SL, Sposto R et al (2002) Non-Hodgkin’s lymphoma arising in bone in children and adolescents is associated with an excellent outcome: a Children’s Cancer Group report. J Clin Oncol 20:2293–301

    Article  PubMed  Google Scholar 

  6. Moritani K, Nakano N, Yonezawa S et al (2018) Usefulness of positron emission tomography-CT for diagnosis of primary bone marrow lymphoma in children. Pediatr Hematol Oncol 35:125–130

    Article  PubMed  Google Scholar 

  7. Borst AJ, States LJ, Reilly AF, Rheingold SR (2013) Determining response and recurrence in pediatric B-cell lymphomas of the bone. Pediatr Blood Cancer 60:1281–6

    Article  PubMed  Google Scholar 

  8. Mulligan ME, McRae GA, Murphey MD (1999) Imaging features of primary lymphoma of bone. AJR Am J Roentgenol 173:1691–7

    Article  CAS  PubMed  Google Scholar 

  9. Weber MA, Papakonstantinou O, Nikodinovska VV, Vanhoenacker FM (2019) Ewing’s sarcoma and primary osseous lymphoma: spectrum of imaging appearances. Semin Musculoskelet Radiol 23:36–57

    Article  PubMed  Google Scholar 

  10. Cıraklı A, Elli M, Dabak N et al (2014) Evaluation of primary bone lymphoma and the importance of positron emission tomography. Acta Orthop Traumatol Turc 48:371–8

    Article  PubMed  Google Scholar 

  11. Suo H, Fu L, Wang Z et al (2020) Primary lymphoma of the tibia in children: Two case reports. Medicine 99:e18807

    Article  PubMed  PubMed Central  Google Scholar 

  12. Subik MK, Herr M, Hutchison RE et al (2014) A highly curable lymphoma occurs preferentially in the proximal tibia of young patients. Mod Pathol 27:1430–1437

    Article  PubMed  PubMed Central  Google Scholar 

  13. Poggio AD, Facchetti L, Ranza A et al (2018) Primary lymphoma of the distal radius of a child: imaging features. Radiol Case Rep 25;13:1279–1284

    Article  Google Scholar 

  14. Huan Y, Qi Y, Zhang W, Chu J (2017) Primary bone lymphoma of radius and tibia: a case report and review of literature. Medicine 96:e6603

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zou H, Yang H, Zou Y et al (2018) Primary diffuse large B-cell lymphoma in the maxilla: a case report. Medicine 97:e10707

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bhatoe HS, Ambastha R (2016) Primary non Hodgkin’s lymphoma of the cranial vault in a child. J Neurooncol 126:209–211

    Article  PubMed  Google Scholar 

  17. Milks KS, McLean TW, Anthony EY (2016) Imaging of primary pediatric lymphoma of bone. Pediatr Radiol 46:1150–7

    Article  PubMed  Google Scholar 

  18. Mengiardi B, Honegger H, Hodler J et al (2005) Primary lymphoma of bone: MRI and CT characteristics during and after successful treatment. AJR Am J Roentgenol 184:185–92

    Article  PubMed  Google Scholar 

  19. Fox MG, Marti JK, Bachmann KR et al (2015) Epiphyseal presentation of non-Hodgkin’s lymphoma of bone in two pediatric patients–one with primary lymphoma of bone. Skeletal Radiol 44:587–95

    Article  PubMed  Google Scholar 

  20. El-Ali AM, Coblentz A, Degnan AJ (2020) Solitary long-bone epiphyseal lesions in children: radiologic-pathological correlation and epidemiology. Pediatr Radiol 50:1724–1734

    Article  PubMed  Google Scholar 

  21. Inarejos Clemente EJ, Navarro OM, Navallas M et al (2022) Multiparametric MRI evaluation of bone sarcomas in children. Insights Imaging 13:33

    Article  PubMed  PubMed Central  Google Scholar 

  22. Paul MR, Kuo DJ (2018) Challenges of assessing response to therapy in non-Hodgkin’s lymphoma of the bone. Case Rep 2018:bcr-2017-223538

    Google Scholar 

  23. Heyning FH, Kroon HM, Hogendoorn PC et al (2007) MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skeletal Radiol 36:937–44

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Boston Children’s Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA

    Patrick Duffy & Kirsten Ecklund

Authors
  1. Patrick Duffy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kirsten Ecklund
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KE conceived of the study concept. Both PD and KE interpreted the images, collected and analyzed the data, and drafted and revised the manuscript. Both authors reviewed and approved of the final manuscript.

Corresponding author

Correspondence to Patrick Duffy.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duffy, P., Ecklund, K. MR features of primary bone lymphoma in children. Pediatr Radiol 53, 2400–2410 (2023). https://doi.org/10.1007/s00247-023-05772-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-023-05772-w

Keywords

Search

Navigation