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Extranodal lymphoma originating in the gluteal muscle with adjacent bone involvement and mimicking a soft tissue sarcoma.

Katsura M, Nishina H, Shigemori Y, Nakanishi T - Int J Surg Case Rep (2015)

Bottom Line: Fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET)/CT showed areas of increased (18)F-FDG uptake in the left gluteal musculature, pelvic bones, para-aortic and mediastinal lymph nodes and both lungs.Histopathological examination showed a diffuse large B cell lymphoma (DLBCL).After 8 cycles of R-CHOP chemotherapy, the mass in the left gluteal muscle has completely disappeared Although destructive tumor originating in the gluteal muscle with adjacent bone involvement is more common in soft tissue sarcoma, lymphoma should be regularly included in the differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Okinawa Prefectural Hokubu Hospital, Okinawa, Japan. Electronic address: morihiro@bj8.so-net.ne.jp.

No MeSH data available.


Related in: MedlinePlus

Histological and immunohistochemical examination of the resected specimen of the left buttock. (A) Hematoxylin and eosin (H–E) staining revealed diffuse infiltration with large atypical lymphoid cells with prominent nucleoli (×400). (B) CD20 immunohistochemical staining demonstrated the presence of large atypical lymphoid cells on the membrane (×400).
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fig0015: Histological and immunohistochemical examination of the resected specimen of the left buttock. (A) Hematoxylin and eosin (H–E) staining revealed diffuse infiltration with large atypical lymphoid cells with prominent nucleoli (×400). (B) CD20 immunohistochemical staining demonstrated the presence of large atypical lymphoid cells on the membrane (×400).

Mentions: A 52-year-old female with a 3-week history of progressive left gluteal pain was referred to our outpatient surgical department. She was previously healthy but had a history of night sweats and weight loss over the prior 2 months. Upon physical examination, a large firm mass was observed in the left buttock, with no inflammation of the skin. No peripheral lymphadenopathy was detected despite thorough examination of the whole body. Standard biochemistry and hematology studies revealed normal results, except for mild elevation of serum lactic dehydrogenase (LDH) and C-reactive protein (CRP). Contrast-enhanced computed tomography (CT) scan of the pelvis revealed a non-uniformly early enhancing mass, approximately 51 × 64 mm in size, in the left gluteal muscle (Fig. 1A). The tumor demonstrated central necrosis and adjacent bone involvement, with destruction of the sacroiliac joint (Fig. 1B). CT scan of the chest showed patchy consolidation in the lower lobes of both lungs. Fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT demonstrated a large area of increased 18F-FDG uptake in the left gluteal musculature [maximum standard uptake value (SUVmax) = 34], the posterior aspect of the left ileum and the sacrum (Fig. 2A). Whole-body 18F-FDG PET/CT identified intense 18F-FDG uptake by the para-aortic and mediastinal lymph nodes, and faint scattered 18F-FDG uptake by both lungs (Fig. 2B). Based on these findings, the clinical and radiographic differential diagnosis was soft tissue sarcoma, malignant lymphoma or metastasis derived from small cell carcinoma of the lung. We then proceeded with an open biopsy of the left gluteal mass for further diagnosis and treatment planning. Pathological studies of the specimen demonstrated dense and diffuse infiltration and proliferation of large atypical lymphoid cells, accompanied by small lymphocytes (Fig. 3A). Immunohistochemical studies showed that the large atypical lymphoid cells were positive for LCA, CD20 and bcl-6, and were negative for cytokeratin, S-100, alpha-SMA and bcl-2 (Fig. 3B). Further, approximately 45% of the large atypical lymphoid cells were positive for MIB-1(Ki-67). Thus, from these results, we diagnosed diffuse large B cell lymphoma (DLBCL) of the left buttock. After staging work-up, including bone marrow biopsy, the patient was finally diagnosed with stage IV DLBCL, low-intermediate risk of the international prognostic index (IPI). Immediately after diagnosis, the patient has received 8 cycles of R-CHOP chemotherapy, and as a result the mass in the left gluteal muscle has completely disappeared (Fig. 4A, B). The patient achieved complete remission after chemotherapy and is currently under the regular follow-up evaluation.


Extranodal lymphoma originating in the gluteal muscle with adjacent bone involvement and mimicking a soft tissue sarcoma.

Katsura M, Nishina H, Shigemori Y, Nakanishi T - Int J Surg Case Rep (2015)

Histological and immunohistochemical examination of the resected specimen of the left buttock. (A) Hematoxylin and eosin (H–E) staining revealed diffuse infiltration with large atypical lymphoid cells with prominent nucleoli (×400). (B) CD20 immunohistochemical staining demonstrated the presence of large atypical lymphoid cells on the membrane (×400).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4336419&req=5

fig0015: Histological and immunohistochemical examination of the resected specimen of the left buttock. (A) Hematoxylin and eosin (H–E) staining revealed diffuse infiltration with large atypical lymphoid cells with prominent nucleoli (×400). (B) CD20 immunohistochemical staining demonstrated the presence of large atypical lymphoid cells on the membrane (×400).
Mentions: A 52-year-old female with a 3-week history of progressive left gluteal pain was referred to our outpatient surgical department. She was previously healthy but had a history of night sweats and weight loss over the prior 2 months. Upon physical examination, a large firm mass was observed in the left buttock, with no inflammation of the skin. No peripheral lymphadenopathy was detected despite thorough examination of the whole body. Standard biochemistry and hematology studies revealed normal results, except for mild elevation of serum lactic dehydrogenase (LDH) and C-reactive protein (CRP). Contrast-enhanced computed tomography (CT) scan of the pelvis revealed a non-uniformly early enhancing mass, approximately 51 × 64 mm in size, in the left gluteal muscle (Fig. 1A). The tumor demonstrated central necrosis and adjacent bone involvement, with destruction of the sacroiliac joint (Fig. 1B). CT scan of the chest showed patchy consolidation in the lower lobes of both lungs. Fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT demonstrated a large area of increased 18F-FDG uptake in the left gluteal musculature [maximum standard uptake value (SUVmax) = 34], the posterior aspect of the left ileum and the sacrum (Fig. 2A). Whole-body 18F-FDG PET/CT identified intense 18F-FDG uptake by the para-aortic and mediastinal lymph nodes, and faint scattered 18F-FDG uptake by both lungs (Fig. 2B). Based on these findings, the clinical and radiographic differential diagnosis was soft tissue sarcoma, malignant lymphoma or metastasis derived from small cell carcinoma of the lung. We then proceeded with an open biopsy of the left gluteal mass for further diagnosis and treatment planning. Pathological studies of the specimen demonstrated dense and diffuse infiltration and proliferation of large atypical lymphoid cells, accompanied by small lymphocytes (Fig. 3A). Immunohistochemical studies showed that the large atypical lymphoid cells were positive for LCA, CD20 and bcl-6, and were negative for cytokeratin, S-100, alpha-SMA and bcl-2 (Fig. 3B). Further, approximately 45% of the large atypical lymphoid cells were positive for MIB-1(Ki-67). Thus, from these results, we diagnosed diffuse large B cell lymphoma (DLBCL) of the left buttock. After staging work-up, including bone marrow biopsy, the patient was finally diagnosed with stage IV DLBCL, low-intermediate risk of the international prognostic index (IPI). Immediately after diagnosis, the patient has received 8 cycles of R-CHOP chemotherapy, and as a result the mass in the left gluteal muscle has completely disappeared (Fig. 4A, B). The patient achieved complete remission after chemotherapy and is currently under the regular follow-up evaluation.

Bottom Line: Fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET)/CT showed areas of increased (18)F-FDG uptake in the left gluteal musculature, pelvic bones, para-aortic and mediastinal lymph nodes and both lungs.Histopathological examination showed a diffuse large B cell lymphoma (DLBCL).After 8 cycles of R-CHOP chemotherapy, the mass in the left gluteal muscle has completely disappeared Although destructive tumor originating in the gluteal muscle with adjacent bone involvement is more common in soft tissue sarcoma, lymphoma should be regularly included in the differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Okinawa Prefectural Hokubu Hospital, Okinawa, Japan. Electronic address: morihiro@bj8.so-net.ne.jp.

No MeSH data available.


Related in: MedlinePlus