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Primary multifocal osseous Hodgkin's lymphoma.

Langley CR, Garrett SJ, Urand J, Kohler J, Clarke NM - World J Surg Oncol (2008)

Bottom Line: He presented with a painful swelling in the sternum, and further investigations revealed deposits in his L1 vertebra, the left sacro-iliac joint and the right acetabulum.The clinical, radiological and histological features of this disease can mimic other medical conditions, including Tuberculosis, making the diagnosis difficult and often leading to delays in treatment.This is a very rare condition and we believe this to be the youngest reported case in the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedic Department, Basingstoke and North Hampshire Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK. clarelangley@hotmail.com

ABSTRACT

Background: Hodgkin's disease (HD) most commonly presents with progressive painless enlargement of peripheral lymph nodes, especially around the cervical region. A few children have systemic symptoms and weight loss. At the time of diagnosis, osseous involvement is uncommon

Case presentation: A case is described of Primary Multifocal Osseous Hodgkin's Lymphoma in a seven-year-old boy. He presented with a painful swelling in the sternum, and further investigations revealed deposits in his L1 vertebra, the left sacro-iliac joint and the right acetabulum.

Conclusion: The clinical, radiological and histological features of this disease can mimic other medical conditions, including Tuberculosis, making the diagnosis difficult and often leading to delays in treatment. This is a very rare condition and we believe this to be the youngest reported case in the literature.

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Related in: MedlinePlus

Plain radiographs (AP and Lateral) of lumbar spine. Demonstrate destruction of the L1 vertebra (arrow).
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Figure 3: Plain radiographs (AP and Lateral) of lumbar spine. Demonstrate destruction of the L1 vertebra (arrow).

Mentions: Five weeks after discharge he represented because of an enlarging sternal mass and the development of back pain with no associated neurology (Figure 3). He remained well with no weight loss or signs and symptoms of systemic disease. An open biopsy of the chest wall mass and a CT guided biopsy of the L1 spinal lesion were performed. These revealed macroscopically caseous material. Mantoux and Heaf tests were negative. An MRI scan of the lumbar spine (Figure 4) showed loss of height of L1 with disease extending bilaterally to the pedicles of T12 and L2. There was a soft tissue mass anterior and posterior to L1 causing spinal stenosis and impingement on the conus. Radiologically this was thought to resemble Potts disease and the macroscopic appearance of the lumbar specimen suggested a diagnosis of tuberculosis. Triple therapy was commenced (Rifampicin, Isoniazid and Pyrazinamide). The specimens were negative for acid fast bacilli, Ziehl-Neelson stain for TB was negative and no organisms were cultured. Subsequent histology from the sternal mass showed Hodgkin's lymphoma (Figure 5). Cells within the specimen were positive for CD30 and CD20 (Figure 6).


Primary multifocal osseous Hodgkin's lymphoma.

Langley CR, Garrett SJ, Urand J, Kohler J, Clarke NM - World J Surg Oncol (2008)

Plain radiographs (AP and Lateral) of lumbar spine. Demonstrate destruction of the L1 vertebra (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2311296&req=5

Figure 3: Plain radiographs (AP and Lateral) of lumbar spine. Demonstrate destruction of the L1 vertebra (arrow).
Mentions: Five weeks after discharge he represented because of an enlarging sternal mass and the development of back pain with no associated neurology (Figure 3). He remained well with no weight loss or signs and symptoms of systemic disease. An open biopsy of the chest wall mass and a CT guided biopsy of the L1 spinal lesion were performed. These revealed macroscopically caseous material. Mantoux and Heaf tests were negative. An MRI scan of the lumbar spine (Figure 4) showed loss of height of L1 with disease extending bilaterally to the pedicles of T12 and L2. There was a soft tissue mass anterior and posterior to L1 causing spinal stenosis and impingement on the conus. Radiologically this was thought to resemble Potts disease and the macroscopic appearance of the lumbar specimen suggested a diagnosis of tuberculosis. Triple therapy was commenced (Rifampicin, Isoniazid and Pyrazinamide). The specimens were negative for acid fast bacilli, Ziehl-Neelson stain for TB was negative and no organisms were cultured. Subsequent histology from the sternal mass showed Hodgkin's lymphoma (Figure 5). Cells within the specimen were positive for CD30 and CD20 (Figure 6).

Bottom Line: He presented with a painful swelling in the sternum, and further investigations revealed deposits in his L1 vertebra, the left sacro-iliac joint and the right acetabulum.The clinical, radiological and histological features of this disease can mimic other medical conditions, including Tuberculosis, making the diagnosis difficult and often leading to delays in treatment.This is a very rare condition and we believe this to be the youngest reported case in the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Orthopaedic Department, Basingstoke and North Hampshire Foundation Trust, Aldermaston Road, Basingstoke, Hampshire, RG24 9NA, UK. clarelangley@hotmail.com

ABSTRACT

Background: Hodgkin's disease (HD) most commonly presents with progressive painless enlargement of peripheral lymph nodes, especially around the cervical region. A few children have systemic symptoms and weight loss. At the time of diagnosis, osseous involvement is uncommon

Case presentation: A case is described of Primary Multifocal Osseous Hodgkin's Lymphoma in a seven-year-old boy. He presented with a painful swelling in the sternum, and further investigations revealed deposits in his L1 vertebra, the left sacro-iliac joint and the right acetabulum.

Conclusion: The clinical, radiological and histological features of this disease can mimic other medical conditions, including Tuberculosis, making the diagnosis difficult and often leading to delays in treatment. This is a very rare condition and we believe this to be the youngest reported case in the literature.

Show MeSH
Related in: MedlinePlus