Primary Lymphoma of Bone (PLB): Lessons Learned from Radiological and Pathological Correlation.
Marilyn M Bui, Jamie Caracciolo, Nicole Riddle, William Bulkeley, Ling Zhang. Moffitt Cancer Center, Tampa; University of South Florida, Tampa
Background: Adult PLB constitutes <1% of non-Hodgkin lymphoma. Because of its rarity and variable clinical and radiographic appearances, patients (pts) often seek initial care from the sarcoma service. However, due to the difference in the management of lymphoma versus sarcoma, it is critical to preoperatively recognize PLB. This study aims to identify the radiological characteristics of PLB and present a practical approach to aid in accurate diagnosis.
Design: A retrospective review of the pathology, radiology and clinical databases from our institution (1999-2009) was performed to identify pts with osseous lymphoma. PLB was defined as (a) a new, solitary bone lesion; (b) no known history of lymphoma; and (c) no evidence of systemic disease at diagnosis. Pathology and radiology data for initial diagnosis were correlated.
Results: Among 160 osseous lymphomas, 53 (33%) represented PLBs. Thirty-three pts had available radiological information. Preoperative differential diagnosis included lymphoma as a primary consideration in only 4 cases (12%). The most common differential diagnoses included metastasis (11) and “malignant or aggressive” (7). Findings on plain radiographs and CT were highly variable. Conversely, MRI revealed more specific findings including infiltrative medullary lesions with an associated extra-osseous mass and minimal cortical disruption relative to the size of the soft tissue component (14) and infiltrative medullary lesions without cortical destruction or an associated extra-osseous mass (9). Bone scans and/or PET scans were positive (12/12). Pathologic diagnosis included 23 (70%) diffuse large B-cell, 6 follicular and 4 other lymphomas. After on-site pathologic evaluation of biopsy and/or surgical specimens in 18 pts, lymphoma was included as a working diagnosis and the specimens were triaged for conformational ancillary studies. No on-site pathologic evaluation was done in 13 pts, which resulted in a second procedure/sampling for confirmation or subtyping.
Conclusions: PLB often presents with nonspecific clinical and imaging findings, thus not well recognized prior to intervention. MRI may provide the most specific imaging characteristics when compared to other imaging modalities. Given the much more common prevalence of other entities, radiologists should at least consider lymphoma in cases of solitary bone lesions, even if only to dismiss it in light of other clinical information. This will alert the pathologist to perform on-site evaluation of the fresh specimen and to triage appropriately for a timely and accurate final diagnosis.
Category: Bone & Soft Tissue
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 12, Tuesday Morning