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Primary multifocal osseous Hodgkin disease: a case report and review of the literature

  • C. Gebert
  • J. Hardes
  • H. Ahrens
  • H. Buerger
  • W. Winkelmann
  • G. Gosheger
Original Paper

Abstract

Purpose

Hodgkin disease (HD) typically involves the lymphatic system at one or more sites. Rarely, Hodgkin disease presents as an osseous lesion without involvement of lymph nodes. Therefore, the histologic diagnosis of osseous HD can be problematic. We present a rare case of multifocal osseous HD and a review the literature with special emphasis on treatment and prognosis.

Methods

Osteomyelitis and lymphoma are the main differential diagnoses and can only be excluded histologically by the presence of Sternberg Reed cells or by immunohistochemical examinations. This case reports a 21-year old man with a Hodgkin lymphoma located at the proximal femur and the proximal tibia.

Results

Staging studies revealed no other tumor manifestations. Regarding the Ann Arbor classification, the presented case should be a stage IV disease. The patient is without evidence of disease 4 years after curettage, local radiation therapy, and systemic chemotherapy despite the poor prognosis considering the Ann Arbor classification.

Conclusion

Reviewing the few reported cases, osseous HD must be distinguished from systemic HD with diffuse bone marrow involvement and from osseous metastases in advanced stage of disease because it seems to have a better prognosis.

Keywords

Osseous Hodgkin disease Bone Lymphoma Tumor 

References

  1. 1.
    Aisenberg AC (1964) Hodgkin’s disease–prognosis, treatment and etiologic and immunologic considerations. N Engl J Med 270:508–514PubMedGoogle Scholar
  2. 2.
    Banks PM (1990) The pathology of Hodgkin’s disease. Semin Oncol 17:683–695PubMedGoogle Scholar
  3. 3.
    Beachley MC, Lau BP, King ER (1972) Bone involvement in Hodgkin’s disease. Am J Roentgenol Radium Ther Nucl Med 114:559–563PubMedGoogle Scholar
  4. 4.
    Behringer K, Josting A, Schiller P, Eich HT, Bredenfeld H, Diehl V, Engert A (2004) Solid tumors in patients treated for Hodgkin’s disease: a report from the German Hodgkin Lymphoma Study Group. Ann Oncol 15:1079–1085PubMedGoogle Scholar
  5. 5.
    Bookman MA, Longo DL (1986) Concomitant illness in patients treated for Hodgkin’s disease. Cancer Treat Rev 13:77–111PubMedGoogle Scholar
  6. 6.
    Borg MF, Chowdhury AD, Bhoopal S, Benjamin CS (1993) Bone involvement in Hodgkin’s disease. Australas Radiol 37:63–66PubMedGoogle Scholar
  7. 7.
    Carey RW, Linggood RM, Wood W, Blitzer PH (1984) Breast cancer developing in four women cured of Hodgkin’s disease. Cancer 54:2234–2236PubMedGoogle Scholar
  8. 8.
    Diehl V, Franklin J, Pfreundschuh M, Lathan B, Paulus U, Hasenclever D, Tesch H, Herrmann R, Dorken B, Muller-Hermelink HK, Duhmke E, Loeffler M (2003) Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med 348:2386–2395PubMedGoogle Scholar
  9. 9.
    Dorfman RF (1971) Relationship of histology to site in Hodgkin’s disease. Cancer Res 31:1786–1793PubMedGoogle Scholar
  10. 10.
    Edeiken-Monroe B, Edeiken J, Kim EE (1990) Radiologic concepts of lymphoma of bone. Radiol Clin North Am 28:841–864PubMedGoogle Scholar
  11. 11.
    Eich HT, Muller RP, Ansen S, Josting A, Engert A, Hansemann K, Pfistner B, Wolf J, Willich N, Diehl V (2003) New therapeutic strategies for Hodgkin lymphoma in cooperation of radiation oncology and medical oncology. Rontgenpraxis 55:114–124PubMedGoogle Scholar
  12. 12.
    Ellis ME, Diehl LF, Granger E, Elson E (1989) Trephine needle bone marrow biopsy in the initial staging of Hodgkin disease: sensitivity and specificity of the Ann Arbor staging procedure criteria. Am J Hematol 30:115–120PubMedGoogle Scholar
  13. 13.
    Eustace S, O’Regan R, Graham D, Carney D (1995) Primary multifocal skeletal Hodgkin’s disease confined to bone. Skeletal Radiol 24:61–63PubMedGoogle Scholar
  14. 14.
    Farber LR, Prosnitz LR, Cadman EC, Lutes R, Bertino JR, Fischer DB (1980) Curative potential of combined modality therapy for advanced Hodgkin’s disease. Cancer 46:1509–1517PubMedGoogle Scholar
  15. 15.
    Franklin J, Diehl V (2002) Current clinical trials for the treatment of advanced-stage Hodgkin’s disease: BEACOPP. Ann Oncol 13 [Suppl 1]:98–101Google Scholar
  16. 16.
    Fried G, Ben Arieh Y, Haim N, Dale J, Stein M (1995) Primary Hodgkin’s disease of the bone. Med Pediatr Oncol 24:204–207PubMedGoogle Scholar
  17. 17.
    Fucilla IS, Hamann A (1961) Hodgkin’s disease in bone. Radiology 77:53–60PubMedGoogle Scholar
  18. 18.
    Glicksman AS, Pajak TF, Gottlieb A, Nissen N, Stutzman L, Cooper MR (1982) Second malignant neoplasms in patients successfully treated for Hodgkin’s disease: a Cancer and Leukemia Group B study. Cancer Treat Rep 66:1035–1044PubMedGoogle Scholar
  19. 19.
    Gold RH, Mirra JM (1979) Case report 101. Primary Hodgkin disease of humerus. Skeletal Radiol 4:233–235PubMedGoogle Scholar
  20. 20.
    Granger W, Whitaker R (1967) Hodgkin’s disease in bone, with special reference to periosteal reaction. Br J Radiol 40:939–948PubMedGoogle Scholar
  21. 21.
    Gross SB, Robertson WW Jr, Lange BJ, Bunin NJ, Drummond DS (1992) Primary Hodgkin’s disease of bone. A report of two cases in adolescents and review of the literature. Clin Orthop: 276–280Google Scholar
  22. 22.
    Halperin EC, Greenberg MS, Suit HD (1984) Sarcoma of bone and soft tissue following treatment of Hodgkin’s disease. Cancer 53:232–236PubMedGoogle Scholar
  23. 23.
    Harrison CN, Gregory W, Hudson GV, Devereux S, Goldstone AH, Hancock B, Winfield D, MacMillan AK, Hoskin P, Newland AC, Milligan D, Linch DC (1999) High-dose BEAM chemotherapy with autologous haemopoietic stem cell transplantation for Hodgkin’s disease is unlikely to be associated with a major increased risk of secondary MDS/AML. Br J Cancer 81:476–483PubMedGoogle Scholar
  24. 24.
    Horan FT (1969) Bone involvement in Hodgkin’s disease. A survey of 201 cases. Br J Surg 56:277–281PubMedGoogle Scholar
  25. 25.
    Kennedy BJ, Fremgen AM, Menck HR (1998) The National Cancer Data Base report on Hodgkin’s disease for 1985–1989 and 1990–1994. Cancer 83:1041–1047PubMedGoogle Scholar
  26. 26.
    Kooremann PJ, Haex AJ (1943) Hodgkin’s disease of the skeleton. Acta Med Scand 115:177–196Google Scholar
  27. 27.
    Lambertenghi-Deliliers G, Annaloro C, Soligo D, Oriani A, Pozzoli E, Quirici N, Luksch R, Polli EE (1992) Incidence and histological features of bone marrow involvement in malignant lymphomas. Ann Hematol 65:61–65PubMedGoogle Scholar
  28. 28.
    List AF, Doll DC, Greco FA (1985) Lung cancer in Hodgkin’s disease: association with previous radiotherapy. J Clin Oncol 3:215–221PubMedGoogle Scholar
  29. 29.
    MacCormick R, Covert A, Gross M (1989) Primary bony involvement in Hodgkin’s disease. CMAJ 140:1059–1060PubMedGoogle Scholar
  30. 30.
    Newcomer LN, Silverstein MB, Cadman EC, Farber LR, Bertino JR, Prosnitz LR (1982) Bone involvement in Hodgkin’s disease. Cancer 49:338–342PubMedGoogle Scholar
  31. 31.
    Ostrowski ML, Inwards CY, Strickler JG, Witzig TE, Wenger DE, Unni KK (1999) Osseous Hodgkin disease. Cancer 85:1166–1178PubMedGoogle Scholar
  32. 32.
    Ozdemirli M, Mankin HJ, Aisenberg AC, Harris NL (1996) Hodgkin’s disease presenting as a solitary bone tumor. A report of four cases and review of the literature. Cancer 77:79–88PubMedGoogle Scholar
  33. 33.
    Spencer J, Dressler R (1936) Lymphoblastoma (Hodgkin’s and sarcoma type) of bone. N Engl J Med: 877–879Google Scholar
  34. 34.
    Stuhlbarg J, Ellis FW (1965) Hodgkin’s disease of bone: favorable prognostic significance? Am J Roentgenol Radium Ther Nucl Med 93:568–572PubMedGoogle Scholar
  35. 35.
    Tesch H, Sieber M, Diehl V (2001) Treatment of advanced stage Hodgkin’s disease. Oncology 60:101–109PubMedGoogle Scholar
  36. 36.
    Thar TL, Million RR (1980) Complications of radiation treatment of Hodgkin’s disease. Semin Oncol 7:174–183PubMedGoogle Scholar
  37. 37.
    Tucker MA, Misfeldt D, Coleman CN, Clark WH Jr, Rosenberg SA (1985) Cutaneous malignant melanoma after Hodgkin’s disease. Ann Intern Med 102:37–41Google Scholar
  38. 38.
    Wallner KE, Leibel SA, Wara WM (1985) Squamous cell carcinoma of the head and neck after radiation therapy for Hodgkin’s disease. A report of two cases and a review of the literature. Cancer 56:1052–1055PubMedGoogle Scholar
  39. 39.
    Wolden SL, Lamborn KR, Cleary SF, Tate DJ, Donaldson SS (1998) Second cancers following pediatric Hodgkin’s disease. J Clin Oncol 16:536–544PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • C. Gebert
    • 1
  • J. Hardes
    • 1
  • H. Ahrens
    • 1
  • H. Buerger
    • 2
  • W. Winkelmann
    • 1
  • G. Gosheger
    • 1
  1. 1.Department of OrthopedicsUniversity of MuensterMuensterGermany
  2. 2.Gerhard-Domagk Institute of PathologyUniversity of MuensterMunsterGermany

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