Skip to main content

Advertisement

SpringerLink
Log in

Epiphyseal presentation of non-Hodgkin’s lymphoma of bone in two pediatric patients—one with primary lymphoma of bone

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

We report two children with lymphoma of bone centered in the distal femoral epiphysis who presented with knee pain. Radiographs, magnetic resonance imaging (MRI) and computed tomography (CT) were performed on both patients prior to biopsy. Following biopsy, both patients had fluorodeoxyglucose (18 F-FDG) positron emission tomography/CT (PET/CT) and whole-body technetium-99m (Tc-99m) scintigraphy performed for staging. One patient met the criteria for primary lymphoma of bone. One patient did not meet the criteria for primary lymphoma of bone because of PET uptake in a popliteal, external iliac and possibly lower abdominal node. Both patients responded well to chemotherapy and are disease free more than 7 years after diagnosis. While an epiphyseal presentation of lymphoma of bone is rare, the efficacy of treatment and the compromised outcome associated with diffuse spread of the disease make early recognition by clinicians important. We present these two cases to increase awareness of the disease and to have clinicians consider it in the differential diagnosis of adolescent epiphyseal lesions.

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
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

References

  1. Limb D, Dreghorn C, Murphy JK, Mannion R. Primary lymphoma of bone. Int Orthop. 1994;18:180.

    CAS  PubMed  Google Scholar 

  2. Resnick D. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: WB Saunders; 2002.

    Google Scholar 

  3. Beatty PT, Björkengren AG, Moore SG, Gelb AB, Gamble JG. Case report 764. Primary lymphoma of bone, large cell, b-phenotype with articular involvement. Skeletal Radiol. 1992;21(8):559–61.

    Article  CAS  PubMed  Google Scholar 

  4. Michaela AI, Giudici MD, Eggli KD, Moser RP, Roloff JS, Frauenhoffer EE, et al. Case report 730. Malignant large cell lymphoma of tibial epiphysis. Skeletal Radiol. 1992;21(4):260–5.

    Google Scholar 

  5. Glotzbecker MP, Kersun LS, Choi JK, Wills BP, Schaffer AA, Dormans JP. Primary non-Hodgkin’s lymphoma of bone in children. J Bone Joint Surg Am. 2006;88:583–94.

    Article  PubMed  Google Scholar 

  6. Doll C, Wulff B, Rossler J, Schaper J, Havers W. Primary B-cell lymphoma of bone in children. Eur J Pediatr. 2001;160:239–42.

    Article  CAS  PubMed  Google Scholar 

  7. Anderson JR, Wilson JF, Jenkin DT, et al. Childhood non-Hodgkin’s lymphoma. The results of a randomized therapeutic trial comparing a 4-drug regimen (COMP) with a 10-drug regimen (LSA2-L2). N Engl J Med. 1983;308:559–65.

    Article  CAS  PubMed  Google Scholar 

  8. Coppes MJ, Patte C, Couanet D, et al. Childhood malignant lymphoma of bone. Med Pediatr Oncol. 1991;19:22–7.

    Article  CAS  PubMed  Google Scholar 

  9. Furman WL, Fitch S, Hustu HO, Callihan T, Murphy SB. Primary lymphoma of bone in children. J Clin Oncol. 1989;7:1275–80.

    CAS  PubMed  Google Scholar 

  10. Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999;173(6):1691–7.

    Article  CAS  PubMed  Google Scholar 

  11. Bacci G, Jaffe N, Emiliani E, Van Horn J, Manfrini M, Picci P, et al. Therapy for primary non-Hodgkin’s lymphoma of bone and a comparison of results with Ewing’s sarcoma. Ten years’ experience at the Istituto Ortopedico Rizzoli. Cancer. 1986;57(8):1468–72.

    Article  CAS  PubMed  Google Scholar 

  12. Garrett KM, Kim HK, Stanek J, Emery KH. MR findings of primary bone lymphoma in a 15-year-old girl: emphasis on diffusion-weighted imaging. Pediatr Radiol. 2011;41(5):658–62.

    Article  PubMed  Google Scholar 

  13. Hermann G, Klein MJ, Abdelwahab IF, Kenan S. MRI appearance of primary non-Hodgkin’s lymphoma of bone. Skeletal Radiol. 1997;26(11):629–32.

    Article  CAS  PubMed  Google Scholar 

  14. Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics. 2003;23(6):1371–83. discussion 1384–7.

    Article  PubMed  Google Scholar 

  15. Stiglbauer R, Augustin I, Kramer J, Schurawitzki H, Imhof H, Radaszkiewicz T. MRI in the diagnosis of primary lymphoma of bone: correlation with histopathology. J Comput Assist Tomogr. 1992;16(2):248–53.

    Article  CAS  PubMed  Google Scholar 

  16. Heyning FH, Kroon HM, Hogendoorn PC, Taminiau AH, van der Woude HJ. MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skeletal Radiol. 2007;36(10):937–44.

    Article  PubMed  Google Scholar 

  17. White LM, Schweitzer ME, Khalili K, Howarth DJ, Wunder JS, Bell RS. MR imaging of primary lymphoma of bone: variability of T2-weighted signal intensity. AJR Am J Roentgenol. 1998;170(5):1243–7.

    Article  CAS  PubMed  Google Scholar 

  18. Carroll G, Breidahl W, Robbins P. Musculoskeletal lymphoma: MRI of bone or soft tissue presentations. J Med Imaging Radiat Oncol. 2013;57(6):663–73.

    Article  PubMed  Google Scholar 

  19. O’Neill J, Finlay K, Jurriaans E, Friedman L. Radiological manifestations of skeletal lymphoma. Curr Probl Diagn Radiol. 2009;38(5):228–36.

    Article  PubMed  Google Scholar 

  20. Borst AJ, States LJ, Reilly AF, Rheingold SR. Determining response and recurrence in pediatric B-cell lymphomas of the bone. Pediatr Blood Cancer. 2013;60(8):1281–6.

    Article  PubMed  Google Scholar 

  21. Kirsch J, Ilaslan H, Bauer TW, Sundaram M. The incidence of imaging findings, and the distribution of skeletal lymphoma in a consecutive patient population seen over 5 years. Skelet Radiol. 2006;35:590–4.

    Article  Google Scholar 

  22. Coley BL, Higinbotham NL, Groesbeck HP. Primary reticulum-cell sarcoma of bone. Radiology. 1950;55(5):41–658.

    Article  Google Scholar 

  23. Wollner N, Lane JM, Marcove RC, Winchester P, Brill P, Mandell L, et al. Primary skeletal non-Hodgkin’s lymphoma in the pediatric age group. Med Pediatr Oncol. 1992;20(6):506–13.

    Article  CAS  PubMed  Google Scholar 

  24. Wang J, Sun NCJ, Nozawa Y, Arber DA, Chu P, Chang KL, et al. Histological and immunohistochemical characterization of extranodal diffuse large-cell lymphomas with prominent spindle cell features. Histopathology. 2001;39:476–81.

    Article  CAS  PubMed  Google Scholar 

  25. Jelinek JS, Murphey MD, Welker JA, Henshaw RM, Kransdorf MJ, Shmookler BM, et al. Diagnosis of primary bone tumors with image-guided percutaneous biopsy: experience with 110 tumors. Radiology. 2002;223(3):731–7.

    Article  PubMed  Google Scholar 

  26. Li Y, Du Y, Luo TY, Yang HF, Yu JH, Xu XX, et al. Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions. Clin Radiol. 2014;69(1):e43–7.

    Article  CAS  PubMed  Google Scholar 

  27. Altuntas AO, Slavin J, Smith PJ, Schlict SM, Powell GJ, Ngan S, et al. Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours. ANZ J Surg. 2005;75(4):187–91.

    Article  PubMed  Google Scholar 

  28. Vieillard MH, Boutry N, Chastanet P, Duquesnoy B, Cotten A, Cortet B. Contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor. Joint Bone Spine. 2005;72(1):53–60.

    Article  PubMed  Google Scholar 

  29. Nouh MR, Abu Shady HM. Initial CT-guided needle biopsy of extremity skeletal lesions: diagnostic performance and experience of a tertiary musculoskeletal center. Eur J Radiol. 2014;83(2):360–5.

    Article  PubMed  Google Scholar 

  30. Yang J, Frassica FJ, Fayad L, Clark DP, Weber KL. Analysis of nondiagnostic results after image-guided needle biopsies of musculoskeletal lesions. Clin Orthop Relat Res. 2010;468(11):3103–11.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Hryhorczuk AL, Strouse PJ, Biermann JS. Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions. Pediatr Radiol. 2011;41(7):848–57.

    Article  PubMed  Google Scholar 

  32. Mathew SE, Madhuri V, Alexander M, Walter NM, Gibikote SV. Florid reactive periostitis of the forearm bones in a child. J Bone Joint Surg Br Vol. 2011;93(3):418–20.

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA

    Michael G. Fox

  2. Department of Radiology and Medical Imaging, University of Virginia, 1218 Lee Street, Box 800170, Charlottesville, VA, 22908, USA

    Jon K. Marti

  3. Wright-Patterson Department of Radiology, Dayton, OH, 45433, USA

    Jon K. Marti

  4. Department of Orthopedics, University of Virginia, P.O. Box 801016, Charlottesville, VA, 22908, USA

    Keith R. Bachmann

  5. Cleveland Clinic, Department of Orthopedic Surgery, 9500, Euclid Ave, Desk A41, Cleveland, OH, 44195, USA

    Keith R. Bachmann

  6. Department of Pathology, University of Virginia, Box 800904, Charlottesville, VA, 22908, USA

    Robin D. LeGallo

  7. Department of Orthopedics, University of Virginia, P.O. Box 801016, Charlottesville, VA, 22908, USA

    William C. Foster

  8. Department of Orthopedic, Virginia Commonwealth University Surgery, Richmond, VA, 23298, USA

    William C. Foster

Authors
  1. Michael G. Fox
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jon K. Marti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keith R. Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robin D. LeGallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William C. Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael G. Fox.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fox, M.G., Marti, J.K., Bachmann, K.R. et al. Epiphyseal presentation of non-Hodgkin’s lymphoma of bone in two pediatric patients—one with primary lymphoma of bone. Skeletal Radiol 44, 587–595 (2015). https://doi.org/10.1007/s00256-014-2010-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-014-2010-7

Keywords

Search

Navigation