Abstract
Primary lymphoma of bone (PLB) is a rare, malignant lymphoid proliferation within bone accounting for less than 3% of all malignant bone tumors. In this case report, a 61-year-old female with past medical history of gout presented with pain and swelling in her right little finger. Initial radiographs demonstrated periostitis and soft tissue swelling about the right little finger. She returned three months later with progressive pain. Subsequent MRI and repeat radiographs demonstrated near complete destruction of the right little finger middle phalanx and periostitis with marrow infiltration at the right long finger. Given the rapid progression of disease, the differential diagnosis consisted primarily of aggressive neoplastic processes. The little finger ray was amputated through the level of the metacarpophalangeal joint and histopathology demonstrated large neoplastic cells that stained positive with CD45, CD20, and PAX5, compatible with diffuse large B-cell lymphoma. A subsequent normal bone marrow aspiration and PET-CT demonstrated no additional sites of disease, thus excluding secondary lymphoma to bone. To the best of our knowledge, this is the first case report of polyostotic PLB involving the hand. PLB of the hands may be initially misdiagnosed due to its rarity and clinical presentation mimicking rheumatological disease. Clinical vigilance in concert with close imaging follow-up is required to make the diagnosis in a timely fashion. We also review the existing PLB hand literature which consists of five cases.
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The data that support the findings of this study are not openly available due to reasons of patient privacy (HIPAA) and are available from the corresponding author upon reasonable request.
References
Oberling C. The reticulosarcomas and the reticulotheliomas of Ewing’s osterosarcoma. Bull Assoc Fr Etude Cancer. 1928;17:259–96.
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 1384–1377).
Bindal P, Desai A, Delasos L, Mulay S, Vredenburgh J. Primary bone lymphoma: a case series and review of literature. Case Rep Hematol. 2020;2020:4254803.
Birlik M, Akar S, Onen F, Ozcan MA, Bacakoglu A, Ozkal S, et al. Articular, B-cell, non-Hodgkin’s lymphoma mimicking rheumatoid arthritis: synovial involvement in a small hand joint. Rheumatol Int. 2004;24(3):169–72.
Kennedy JW, Wong LK, Kalantarian B, Turner L, Hayes CW. An unusual presentation of methotrexate-induced B-cell lymphoma of the metacarpophalangeal joint: a case report and literature review. J Hand Surg Am. 2006;31(7):1193–6.
Yeom JA, Song YS, Lee IS, Choi KU, Kim JI. A rare manifestation of solitary primary bone lymphoma of the finger: a case report. Invest Magn Reso Imaging. 2018;22:4.
Galati V, Wortmann F, Stang FH, Thorns C, Mailander P, Kisch T. A rare manifestation of primary bone lymphoma: solitary diffuse large B cell lymphoma of the little finger. J Hand Surg Am. 2018;43(8):779 e771-779 e774.
Gordon MJ, Peterson BA, Skubitz KM. Lymphoma of the hands in a patient with rheumatoid arthritis: case report. J Hand Surg Am. 2014;39(4):728–31.
Kennedy G, Weir P, Johnston K, Elder P. Surgical management of primary bone lymphoma of the hip: a case report and review of the literature. Case Rep Orthop. 2019;2019:3174768.
Fletcher CDM, Bridge JA, Hogendoorn PCW, Fletcher CDM, Bridge JA, Hogendoorn P. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer (IARC) (UN); 2013. pp. 316–8.
Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999;173(6):1691–7.
Heyning FH, Kroon HM, Hogendoom 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.
Murphey MD, Kransdorf MJ. Primary musculoskeletal lymphoma. Radiol Clin North Am. 2016;54(4):785–95.
Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer. 2010;116(4):871–9.
de Camargo OP, dos Santos Machado TM, Croci AT, de Oliveira CR, Giannotti MA, Baptista AM, et al. Primary bone lymphoma in 24 patients treated between 1955 and 1999. Clin Orthop Relat Res. 2002;397:271–80.
Zhou H-Y, Gao F, Bu B, Fu Z, Sun X-J, Huang C-S, et al. Primary bone lymphoma: a case report and review of the literature. Oncol Lett. 2014;8(4):1551–6.
Alizadeh AA, Eisen MB, Davis RE, Ma C, Lossos IS, Rosenwald A, et al. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature. 2000;403(6769):503–11.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Thiele J (Eds): WHO classification of tumours of haematopoietic and lymphoid tissues (Revised 4th edition). IARC: Lyon 2017
Nowakowski GS, LaPlant B, Macon WR, Reeder CB, Foran JM, et al. Lenalidomide combined with R-CHOP overcomes negative prognostic impact of non-germinal center B-cell phenotype in newly diagnosed diffuse large B-Cell lymphoma: a phase II study. J Clin Oncol. 2015;33(3):251–7.
Dunn NA, Grahame-Smith H, Doherty M. “Disappearing foot disease”: an unusual presentation of primary lymphoma of bone. J R Soc Med. 1989;82(5):302–3.
Ciftdemir M, Ustabasioglu FE, Colbe SA, Ustun F, Usta U, Cicin I. Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: a retrospective study. Acta Orthop Traumatol Turc. 2021;55(1):67–72.
Ramadan KM, Shenkier T, Sehn LH, Gascoyne RD, Connors JM. A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population-based study of successively treated cohorts from the British Columbia Cancer Agency. Ann Oncol. 2007;18(1):129–35.
Acknowledgements
We would like to acknowledge the Oregon Health & Science University Department of Pathology and Laboratory Medicine. Additionally, we would like to acknowledge the American College of Radiology Institute for Radiographic Pathology.
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The authors received no funding for this work. Barbon DB, receives royalties from Elsevier, Inc.
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Barbon, D.A., Williams, T.P., Hulse, H.B. et al. Primary lymphoma of bone of the little finger: a case report and review of the literature. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04576-9
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DOI: https://doi.org/10.1007/s00256-024-04576-9