A rare presentation of primary lymphoma of bone with aneurysmal bone cyst-like changes
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CASE REPORT
A rare presentation of primary lymphoma of bone with aneurysmal bone cyst-like changes L. G. Shyamasundar 1 & Madhavi Kandagaddala 2 & Anne Jennifer 3 & Thomas Palocaren 4 Received: 20 August 2020 / Revised: 24 September 2020 / Accepted: 30 September 2020 # ISS 2020
Abstract Primary lymphoma of bone occurs rarely in children with variable imaging findings ranging from a lytic lesion to an aggressive permeative lesion. We detail a case report with review of literature of a 14-year-old boy with a rare presentation of primary lymphoma of bone with aneurysmal bone cyst-like changes. The lesion was surgically excised as management for aneurysmal bone cyst but histopathological examination of the excised tissue revealed a non-Hodgkin’s type of lymphoma. This unique type of aneurysmal bone cyst-like presentation has not been well characterised until now in the imaging spectrum of primary lymphoma of bone. Clinicians need to be aware of this uncommon presentation for early intervention and appropriate management of this malignancy in children. Keywords Children . Primary lymphoma of bone . Non-Hodgkin’s lymphoma . Aneurysmal bone cyst
Introduction Primary lymphoma of bone (PLB) is a rare malignant condition with lymphocytic infiltration of the bone; it accounts for 2–3% of all primary bone tumours in adults and children [1]. Furthermore, it comprises < 1% of all lymphomas [2] and 5% of extra-nodal non-Hodgkin’s lymphomas [3]. Primary lymphoma of bone is a rare entity, especially in children; most reports have described a median age of presentation for this disease in the fourth and fifth decades [4]. Among the lymphomas, non-Hodgkin’s lymphoma is the most frequent in children with a worldwide incidence rate of 4.4–6.8 cases per million children per year [5]. The clinical
L. G. Shyamasundar and Madhavi Kandagaddala are joint first authors. * Thomas Palocaren [email protected] 1
Department of Orthopaedics, Bangalore Baptist hospital, Bengaluru, Karnataka, India
2
Department of Radiology, Christian Medical College, Vellore, Tamilnadu, India
3
Department of General pathology, Christian Medical College, Vellore, Tamilnadu, India
4
Department of Pediatric Orthopaedics, Christian Medical College, Vellore, Tamilnadu, India
presentation is often non-specific, intermittent regional pain being the most common presentation. The imaging features are variable and non-specific. The radiographic appearance ranges from lytic, mixed lytic-sclerotic, or purely sclerotic and can be nearly undetectable. These lesions can be monostotic or polyostotic [6]. We report a child with a unique type of presentation of primary lymphoma of bone with aneurysmal bone cyst-like changes (ABC-like) which has not been described in literature previously to the best of our knowledge. Clinicians need to be aware of this unusual radiological presentation for early diagnosis and timely management of this malignancy.
Case report A 14-year-old boy presented with a history of left groin pain exacerbated by exertional activities like
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