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Unusual primary osseous Hodgkin's lymphoma: A case report.

Luo W, Zhang F, Sun J, He H - Oncol Lett (2014)

Bottom Line: The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma.This makes it difficult to diagnose the condition, which often leads to a delay in treatment.Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.

ABSTRACT

Hodgkin's lymphoma (HL) is one of the few adult malignancies that most frequently presents with a progressive, painless enlargement of the peripheral lymph nodes. A primary osseous presentation of HL, without lymph node involvement, is extremely rare. The present study describes a case of primary multifocal osseous HL in a 22-year-old female. The patient presented with pain in the lumbar-sacral-pelvic area and a prolonged fever. Pathological examination led to a diagnosis of primary multifocal osseous lymphoma, and the patient was subsequently prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. Following this, the patient recovered with no pain or fever, and computed tomography identified no further progression. The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma. Furthermore, in rare cases, HL may even occur in combination with multiple myeloma. This makes it difficult to diagnose the condition, which often leads to a delay in treatment. Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

No MeSH data available.


Related in: MedlinePlus

Biopsy sample demonstrating that cells with the typical morphology of Reed-Sternberg (RS) cells, with abundant cytoplasm and prominent eosinophilic nucleoli, were scattered against a background of reactive inflammation. Immunohistochemistry staining of the RS population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15.
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f4-ol-09-02-0677: Biopsy sample demonstrating that cells with the typical morphology of Reed-Sternberg (RS) cells, with abundant cytoplasm and prominent eosinophilic nucleoli, were scattered against a background of reactive inflammation. Immunohistochemistry staining of the RS population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15.

Mentions: Upon presentation, the blood cell count revealed a persistent elevation of white blood cells (>14.0×109 g/l; normal range, 4.0–10.0×109 g/l), and a lowered hemoglobin level (<90 g/l; normal range, 120–150 g/l). The platelet count was also elevated (469.0×109 g/l; normal range, 100–300×109 g/l) and the mean corpuscular volume was <80 fl (normal range, 80–100 fl). The mean corpuscular hemoglobin (MCH) level was <27 pg (normal range, 27–34 pg) and the MCH concentration was <320 g/l (normal range, 320–360 g/l), which suggested microcytic hypochromic anemia. The liver and renal function tests were almost normal; the biochemical evaluation demonstrated signs of inflammation, with levels of 130 mg/l C-reactive protein (CRP) (normal range, 0–8 mg/l) and 0.21 ng/ml procalcitonin (normal range, <0.05 ng/ml), and a 75-mm/h erythrocyte sedimentation rate (ESR) (normal range, 0–20 mm/h). Further serology tests, including the human leukocyte antigen haplotype B27, tuberculosis antibody, light chain protein and extractable nuclear antigens tests, rheumatism immunity and lupus tests, thyroid gland function test and an examination of 12 tumor markers, were all normal. A pelvic X-ray revealed a bone lesion in each of the sacroiliac joints five months after the onset of symptoms (Fig. 1). Computed tomography (CT) identified osteolysis in each sacroiliac joint and the left greater trochanter (Fig. 2). Single-photon emission CT revealed abnormal bone metabolism of the lumbar, sacroiliac joint, the left greater trochanter and the left shoulder (Fig. 3), likely sites of bone metastases. A B-mode ultrasound scan of the cervical and abdominal regions revealed no augmented lymph nodes, and the organs of the abdominal cavity were normal. CT of the lungs and mediastinum, and magnetic resonance imaging of the abdominal region, revealed no enlargement of the lymph nodes and no extraosseous involvement. Scans were combined with a physical examination, which revealed no signs of lymphadenectasis. Positron emission tomography-CT was not recommended due to its high cost and the exposure of the patient to radioactivity. The color ultrasonography images of gynecological features, and the color Doppler ultrasonography of the heart, were normal. Due to the patient’s history of multifocal bone pain and a negative bone marrow biopsy, the clinical profile appeared to be consistent with a diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Furthermore, the initial biopsy from the left posterior-superior iliac spine also revealed several giant cells against a background of inflammation. Although combination treatment with antibiotics [3.0 g cefperazone-sulbactam, intravenous glucose tolerance test (i.v.g.t.t.), every 8 h; and 1.2 g clindamycin, i.v.g.t.t., every 12 h)] and non-steroidal anti-inflammatory drugs (100 mg flurbiprofen, i.v.g.t.t., every 12 h) for three weeks greatly improved the symptoms, CT revealed that bone destruction was still occurring. A definitive diagnosis was not reached, as the possibility of inflammation, a tumor or even intoxication could not be eliminated. A second biopsy was performed, which retrieved a large amount of tissue for pathological examination. The results of the pathological examination revealed that the tissue contained cells bearing the characteristic morphology of RS cells, with abundant cytoplasm and marked eosinophilic nucleoli, dispersed against a background of reactive inflammation. The immunohistochemistry staining of the RS cell population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15 (Fig. 4). These results led to a diagnosis of primary multifocal osseous lymphoma, rather than CRMO. Finally, in the hematology ward, the patient was prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy, and recovered with no pain or fever. The patient was also able to walk normally subsequent to chemotherapy. The biochemical examination revealed that the patient’s CRP, ESR and procalcitonin levels had returned to normal. Furthermore, CT identified no further progression of bone destruction of the lumbar, sacroiliac joint, the left greater trochanter and the left shoulder. The patient returned to the hospital six months later for a follow-up consultation, and reported no pain or fever.


Unusual primary osseous Hodgkin's lymphoma: A case report.

Luo W, Zhang F, Sun J, He H - Oncol Lett (2014)

Biopsy sample demonstrating that cells with the typical morphology of Reed-Sternberg (RS) cells, with abundant cytoplasm and prominent eosinophilic nucleoli, were scattered against a background of reactive inflammation. Immunohistochemistry staining of the RS population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301495&req=5

f4-ol-09-02-0677: Biopsy sample demonstrating that cells with the typical morphology of Reed-Sternberg (RS) cells, with abundant cytoplasm and prominent eosinophilic nucleoli, were scattered against a background of reactive inflammation. Immunohistochemistry staining of the RS population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15.
Mentions: Upon presentation, the blood cell count revealed a persistent elevation of white blood cells (>14.0×109 g/l; normal range, 4.0–10.0×109 g/l), and a lowered hemoglobin level (<90 g/l; normal range, 120–150 g/l). The platelet count was also elevated (469.0×109 g/l; normal range, 100–300×109 g/l) and the mean corpuscular volume was <80 fl (normal range, 80–100 fl). The mean corpuscular hemoglobin (MCH) level was <27 pg (normal range, 27–34 pg) and the MCH concentration was <320 g/l (normal range, 320–360 g/l), which suggested microcytic hypochromic anemia. The liver and renal function tests were almost normal; the biochemical evaluation demonstrated signs of inflammation, with levels of 130 mg/l C-reactive protein (CRP) (normal range, 0–8 mg/l) and 0.21 ng/ml procalcitonin (normal range, <0.05 ng/ml), and a 75-mm/h erythrocyte sedimentation rate (ESR) (normal range, 0–20 mm/h). Further serology tests, including the human leukocyte antigen haplotype B27, tuberculosis antibody, light chain protein and extractable nuclear antigens tests, rheumatism immunity and lupus tests, thyroid gland function test and an examination of 12 tumor markers, were all normal. A pelvic X-ray revealed a bone lesion in each of the sacroiliac joints five months after the onset of symptoms (Fig. 1). Computed tomography (CT) identified osteolysis in each sacroiliac joint and the left greater trochanter (Fig. 2). Single-photon emission CT revealed abnormal bone metabolism of the lumbar, sacroiliac joint, the left greater trochanter and the left shoulder (Fig. 3), likely sites of bone metastases. A B-mode ultrasound scan of the cervical and abdominal regions revealed no augmented lymph nodes, and the organs of the abdominal cavity were normal. CT of the lungs and mediastinum, and magnetic resonance imaging of the abdominal region, revealed no enlargement of the lymph nodes and no extraosseous involvement. Scans were combined with a physical examination, which revealed no signs of lymphadenectasis. Positron emission tomography-CT was not recommended due to its high cost and the exposure of the patient to radioactivity. The color ultrasonography images of gynecological features, and the color Doppler ultrasonography of the heart, were normal. Due to the patient’s history of multifocal bone pain and a negative bone marrow biopsy, the clinical profile appeared to be consistent with a diagnosis of chronic recurrent multifocal osteomyelitis (CRMO). Furthermore, the initial biopsy from the left posterior-superior iliac spine also revealed several giant cells against a background of inflammation. Although combination treatment with antibiotics [3.0 g cefperazone-sulbactam, intravenous glucose tolerance test (i.v.g.t.t.), every 8 h; and 1.2 g clindamycin, i.v.g.t.t., every 12 h)] and non-steroidal anti-inflammatory drugs (100 mg flurbiprofen, i.v.g.t.t., every 12 h) for three weeks greatly improved the symptoms, CT revealed that bone destruction was still occurring. A definitive diagnosis was not reached, as the possibility of inflammation, a tumor or even intoxication could not be eliminated. A second biopsy was performed, which retrieved a large amount of tissue for pathological examination. The results of the pathological examination revealed that the tissue contained cells bearing the characteristic morphology of RS cells, with abundant cytoplasm and marked eosinophilic nucleoli, dispersed against a background of reactive inflammation. The immunohistochemistry staining of the RS cell population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15 (Fig. 4). These results led to a diagnosis of primary multifocal osseous lymphoma, rather than CRMO. Finally, in the hematology ward, the patient was prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy, and recovered with no pain or fever. The patient was also able to walk normally subsequent to chemotherapy. The biochemical examination revealed that the patient’s CRP, ESR and procalcitonin levels had returned to normal. Furthermore, CT identified no further progression of bone destruction of the lumbar, sacroiliac joint, the left greater trochanter and the left shoulder. The patient returned to the hospital six months later for a follow-up consultation, and reported no pain or fever.

Bottom Line: The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma.This makes it difficult to diagnose the condition, which often leads to a delay in treatment.Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China.

ABSTRACT

Hodgkin's lymphoma (HL) is one of the few adult malignancies that most frequently presents with a progressive, painless enlargement of the peripheral lymph nodes. A primary osseous presentation of HL, without lymph node involvement, is extremely rare. The present study describes a case of primary multifocal osseous HL in a 22-year-old female. The patient presented with pain in the lumbar-sacral-pelvic area and a prolonged fever. Pathological examination led to a diagnosis of primary multifocal osseous lymphoma, and the patient was subsequently prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. Following this, the patient recovered with no pain or fever, and computed tomography identified no further progression. The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma. Furthermore, in rare cases, HL may even occur in combination with multiple myeloma. This makes it difficult to diagnose the condition, which often leads to a delay in treatment. Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

No MeSH data available.


Related in: MedlinePlus