Proximal Tibia Is a Common Site for Bone Lymphoma in Young Patients
M Kristina Subik, Kristen A Mead, Robert E Hutchison, W Richard Burack. University of Rochester Medical Center, Rochester, NY; SUNY Upstate Medical University, Syracuse, NY
Background: In the course of our practice, we observed two male patients, ages 18 and 19, whose chief complaint was knee pain and whose biopsy of the proximal tibia (PT) was diagnostic of a B cell lymphoma. In both cases, the PT was preferentially involved. One patient had bilateral PT involvement, the other limited to the right PT. The latter was treated with local irradiation and recurred 17 months later in the left PT. These cases prompted us to review all lymphomas with an initial diagnosis in bone.
Design: Pathology and clinical records from 2001-11 identified all lymphomas diagnosed in a bone biopsy (excluding iliac crest) directed at a radiographic lesion. To assess the reproducibility of the observations, pathology records at a second institution were examined.
Results: Lymphoma presenting in bone as the initial lesion was identified in 46 patients with a median age of 59 years (range 13-85), a slight male predominance (M:F - 1.6:1), all B cell, and 27 were DLBCL. Of the 13 patients who were less than 40 years old, 9 had lymphoma in the PT. 10 patients presented with knee pain and imaging studies that prompted a PT biopsy. The median age for the PT patients was 22.5 years with a marked male predominance (M:F - 4:1). The histologic types were: 8 DLBCL, 1 “low grade”, and 1 “unclassifiable”. 4 PT patients fulfilled criteria for Primary Bone Lymphoma. Treatment modalities for the PT lymphomas included a pediatric ALL-protocol, R-CHOP, and local irradiation alone. 8 PT patients achieved complete remission with median follow-up of 21 months. The records of a second institution showed 5 patients with lymphoma of the PT, all male, with a median age of 29 years (range 19-48).
Conclusions: Proximal tibial presentation of lymphoma is common and, in contrast to reported series of Primary Bone Lymphoma, tends to occur in young males. Further investigation will be needed to determine whether an inflammatory process, repetitive injuries, or growth spurt during puberty contribute to this localization.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 203, Tuesday Afternoon