Pathologic Fractures Secondary to Primary Non-Hodgkin’s Lymphoma of Bone: A Report of Two Cases Treated with Surgery
Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 16-19 | Abigail R Tud, Celestine Marie G Trinidad. DOI:0.13107/jbst.2021.v07i03.61
Author: Abigail R Tud [1], Celestine Marie G Trinidad [2]
[1] Musculoskeletal Tumor Unit, Philippine Orthopedic Center, Quezon City, Manila, Philippines.
[2] Department of Pathology, Philippine Orthopedic Center, Quezon City, Manila, Philippines.
Address of Correspondence
Dr. Abigail R Tud,
Musculoskeletal Tumor Unit, Philippine Orthopedic Center, Quezon City, Manila, Philippines.
E-mail: abitud.pocmtu@gmail.com
Abstract
Background: Primary lymphoma of bone (PLB) is a rare condition accounting for <2% of lymphomas among adults. Diagnosis is confirmed through clinical features, radiologic findings, and immunohistochemical studies. Treatment consists primarily of chemotherapy and radiotherapy. A lack of consensus remains, however, regarding the role of surgery on prognosis. Interventions with potential to improve quality of life therefore warrant further investigation. The authors report two cases of PLB treated with surgery, with favorable outcomes.
Case Presentation 1: A 21-year-old female presented with the left knee pain unaccompanied by constitutional symptoms. Imaging studies showed an isolated pathologic fracture of the left proximal tibia. Histopathology showed an atypical proliferation of large round cells, which stained diffusely and strongly positive for CD20. 90% of the cells also stained positive for the proliferation marker Ki-67. These findings were consistent with a high-grade B-Cell non-Hodgkin’s lymphoma (NHL). The tibial lesion was managed with direct fracture reduction and knee arthrodesis. Six cycles of chemotherapy were completed. Current Musculoskeletal Tumor Society (MSTS) score is 28/30, without evidence of recurrence 3 years post-surgery.
Case Presentation 2: A 69-year-old male sustained a pathologic subtrochanteric fracture after falling on his left hip. Diagnostic imaging revealed no other osseous lesions. Biopsy specimens showed a proliferation of atypical lymphoid cells, and on immunohistochemistry, these were diffusely and strongly positive for lymphocyte common antigen (CD45) and CD20. This was consistent with a high-grade B-Cell NHL. After proximal femoral nailing was performed, no further treatment was given. The patient is currently 2 years post-surgery with MSTS score of 28/30, and no signs of recurrence or metastases.
Conclusion: Current approach to treatment of PLB is multi-modal, but guidelines for surgical intervention are unavailable. Few reports have been made on outcomes after surgery. Pathologic fracture fixation is an option among select patients, affording satisfactory functional outcomes while minimizing morbidity.
Keywords: Knee resection arthrodesis, Non-Hodgkin’s lymphoma of bone, pathologic fracture, primary lymphoma of bone.
References:
1. Scoccianti G, Rigacci L, Puccini B, Campanacci DA, Simontacchi G, Bosi A, et al. Primary lymphoma of bone: outcome and role of surgery. Int Orthop 2013;37:2437-42.
2. Tsoucalas G, Papaioannou TG, Mainta I, Thomaidis V, Fiska A. A rare case of a non-Hodgkin’s lymphoma presented as a single bone lesion. Biomed J Sci Tech Res 2018;3:1-3.
3. Singh T, Satheesh CT, Lakshmaiah KC, Suresh TM, Babu GK, Lokanatha D, et al. Primary bone lymphoma: A report of two cases and review of the literature. J Can Res Ther 2010;6:296-8.
4. Coley BL, Higginbotham NL, Groesbeck HP. Primary reticulum cell sarcoma of bone; summary of 37 cases. Radiology 1950;55:641-58.
5. Jacobs AJ, Michels R, Stein J, Levin AS. Socioeconomic and demographic factors contributing to outcomes in patients with primary lymphoma of bone. J Bone Oncol 2015;4:32-6.
6. Jawad MU. Primary lymphoma of bone in adult patients. Cancer 2010;116:871-9.
7. Kitsoulis P, Vlychou M, Papoudou-Bai A, Karatzias G, Charchanti A, Agnantis NJ, et al. Primary lymphomas of bone. Anticancer Res 2006;26:325-38.
8. Mavrogenis AF, Angelini A, Pala E, Zinzani P, Ruggieri P. The role of surgery for haematologic neoplasms of bone. Acta Orthop Belg 2012;78:382-92.
9. Messina C, Christie D, Zucca E, Gospodarowicz M, Ferreri AJ. Primary and secondary bone lymphomas. Cancer Treatment Rev 2015;41:235-46.
10. Bhagavathi S, Fu K. Primary lymphoma of bone: Areview. Semin Diagn Pathol 2014;31:48-52.
11. Bhagavathi S, Micale MA, Les K, Wilson JD, Wiggins ML, Fu K. Primary bone diffuse large B-cell lymphoma. Am J Surg Pathol 2009;33:1463-9.
| How to Cite this article: Tud AR, Trinidad CMG | Pathologic fractures secondary to primary non-Hodgkin’s lymphoma of bone: A report of two cases treated with surgery. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 16-19. |
