Epiphyseal lymphoid infiltrates of the knee in adolescents
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CASE REPORT
Epiphyseal lymphoid infiltrates of the knee in adolescents Lukas Urbanschitz 1 & Christoph Amadeus Agten 2 & Marco Matteo Bühler 3 & Marie Sarah Wetzel 2 & Daniel Andreas Müller 1 Received: 23 July 2020 / Revised: 22 August 2020 / Accepted: 27 August 2020 # ISS 2020
Abstract We present three adolescents with focal lesions of the distal femur that were shown to be benign aggregates of small lymphocytes and plasma cells of unknown origin. The patients were within the age of 12 and 14 years. All lesions presented with similar MRI findings and provided the same histopathological findings in the biopsy. Although all lesions increased in size, only one patient remained symptomatic and underwent subsequent tumor resection. To our best knowledge, tumor or pseudotumoral epiphyseal lymphoid infiltrates as seen in these three patients have not previously been described. We recommend a biopsy to rule out a malignant tumor or an infection. Observation, without further invasive testing in asymptomatic patients, is recommended until the resolution of the lesions. However, if a lesion becomes symptomatic, surgical resection should be considered. Keywords Adolescents . Lymphoid . Infiltrates . Knee: Tumor . Epiphyseal
Introduction We observed three cases of adolescent patients with strikingly similar radiological and histological tumors, not previously seen at our sarcoma center, which identified as epiphyseal lymphoid infiltrates. It is crucial that these lesions are differentiated from other tumors, tumor-like lesions, and infection in the skeletally immature patient. Although the lesions
* Lukas Urbanschitz [email protected] Christoph Amadeus Agten [email protected] Marco Matteo Bühler [email protected] Marie Sarah Wetzel [email protected] Daniel Andreas Müller [email protected] 1
Orthopaedic surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
2
Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
3
Institute of Pathology and Molecularpathology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
exhibited some similarity to other extraordinary, rare bone lesions such as chronic recurrent multifocal osteomyelitis [1], Rosai-Dorfman disease [2] (RDD), and primary lymphoma [3] of the bone, they did not fully match their diagnostic criteria. It is the aim of this article to describe these lesions, their imaging findings, histopathology, and their clinical relevance. This article also gives directive to the further clinical decision-making for patients if an epiphyseal lymphoid infiltrate of the knee is present.
Case report Patient 1 She was first administered to our clinic at the age of 14 with diffuse atraumatic joint pain and swelling. Clinically, she presented with diffuse tenderness and slight joint effusion. The range of motion was unremarkable and the knee was ligamentary stable. The baseline magnetic resonance imaging showed a T1-hypointense and STIR hyperintense lesion of dista
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