Lymphoma of Bone

• = RETICULUM CELL SARCOMA = HISTIOCYTIC LYMPHOMA

= PRIMARY LYMPHOMA OF BONE
• = singular bone lesion
• the generalized form of reticulum cell sarcoma is lymphoma
Prevalence 5% of all primary bone tumors; <1% of all NHL; 2–6% of all
: primary malignant bone tumors in children
• Incidence of bone marrow involvement:
o 5–15% in Hodgkin disease;
o 25–40% in non-Hodgkin lymphoma
o Bone marrow involvement indicates progression of disease
o Bone marrow imaging-guidance for biopsy!
NUC: 40% sensitivity; 88% specificity
MR: 65% sensitivity; 90% specificity
Histo mostly large B-cell category; sheets of reticulum cells, larger than those
: in Ewing sarcoma (DDx: myeloma, inflammation, osteosarcoma,
eosinophilic granuloma)
Age: bimodal distribution with peaks in 2nd–3rd and 5th–6th decades;
50% <40 years; 35% <30 years; M:F = 2:1
• • chronic dull pain
• • striking contrast between size of lesion + patient's well-being
Location lower femur, upper tibia (40% about knee), humerus, pelvis, scapula,
: ribs, vertebra
Site: dia- / metaphysis
• cancellous bone erosion (earliest sign)
• mottled permeative pattern of separate coalescent areas
• late cortical destruction
• lamellated / sunburst periosteal response (rare and less than in Ewing
sarcoma)
• lytic / reactive new-bone formation
• associated soft-tissue mass without calcification (70%)
• synovitis of knee joint common

Cx: pathologic fracture (most common among malignant bone tumors)

Prognosis 54% 5-year survival
:
DDx: (1) Osteosarcoma (less medullary extension, younger patients)
(2) Ewing tumor (systemic symptoms, debility, younger patients)
(3) Metastatic malignancy (multiple bones involved, more
destructive)