Non‐hodgkin's lymphoma of the synovium simulating rheumatoid arthritis

Dorfman, Howard D.; Siegel, Howard L.; Perry, Michael C.; Oxenhandler, Ronald W.

doi:10.1002/art.1780300205

Cited by 62 publications

(16 citation statements)

References 27 publications

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“…Non-Hodgkin lymphoma is known to have skeletal involvement in up to 25% of cases,1 and the involvement of the synovium is usually via direct extension from bone lesions 2. This case, however, demonstrates a primary tumour to the synovium without bony involvement.…”

Section: Discussionmentioning

confidence: 99%

Large B cell lymphoma of the subtalar and talonavicular joint synovium

George¹,

Afsharpad

Chifu

et al. 2013

BMJ Case Reports

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SUMMARYWe present the unique case of a 68-year-old man with a background of rheumatoid arthritis, who underwent left subtalar and talonavicular arthrodesis due to degenerative changes and chronic pain. Histology of the synovium demonstrated large B cell lymphoma. The patient subsequently underwent R-CHOP chemotherapy and radiotherapy to the affected area. This is the first described case of a primary large B cell lymphoma of the subtalar and talonavicular joints, without bony involvement. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Large B cell lymphoma of the subtalar and talonavicular joint synovium

George¹,

Afsharpad

Chifu

et al. 2013

BMJ Case Reports

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“…Previous reports, however, were of T cell4 rather than B cell lymphoma occurring with panniculitis and the good response to corticosteroids is unusual for a paraneoplastic syndrome. Seronegative polyarthritis has been reported as a rheumatological manifestation of B and T cell lymphomas2 5 6 and arthritis indistinguishable from seronegative rheumatoid arthritis has been described in association with cutaneous T cell lymphoma 2. The RS 3 PE syndrome (remitting seronegative symmetrical synovitis with pitting oedema)7 has been reported in association with non-Hodgkin’s lymphoma8 and other malignant tumours 9.…”

Section: Discussionmentioning

confidence: 99%

“Rheumatoid nodules” and lymphoma!

Courtney

Wright

Finch

1998

Annals of the Rheumatic Diseases

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Case historyA 63 year old woman presented with painful, stiV hands. There was swelling of the hands, ankles and feet but no systemic upset. On examination there was soft tissue thickening of the proximal interphalangeal (PIP) and metacarpal phalangeal (MCP) joints of the hands with pitting oedema of the hands, feet and lower legs. The remainder of the examination was unremarkable. The following investigations were negative or normal. Full blood count and diVerential, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), rheumatoid factor, nuclear antibody profile, thyroid function. Serological investigation for parvovirus B19 was negative. Radiographs of the hands revealed soft tissue swelling but no erosions.During the following six months the patient developed synovitis of PIP joints and wrists (fig1) with bilateral dorsal sheath eVusions ( fig 2). Multiple firm nodules were noted on both elbows and forearms measuring up to 1 cm (fig 2) and she developed symptoms and signs of carpal tunnel syndrome.The patient now fulfilled ARA 1987 diagnostic criteria for rheumatoid arthritis 1 with early morning stiVness, swelling of PIP joints for greater than six weeks, symmetrical joint swelling, and rheumatoid nodules. There were, however, atypical features; the ESR was normal, the rheumatoid factor was negative, and there was marked peripheral oedema. Further investigations were performed. Immunoglobulins, vasculitis profile and C3,C4, C3d were normal. Brucella, hepatitis A and B, and Borrelia serology was negative. Chest radiograph and isotype bone scan were normal. Histological examination of the nodules revealed a mixed inflammatory cell infiltrate consisting of lymphocytes, mononuclear cells, and histiocytes. There was some destruction of blood vessels and collagen fibres. Central fibrinoid necrosis with macrophage palisading, characteristic of a rheumatoid nodule, were not identified. Biopsy of peripheral oedematous skin revealed superficial and deep panniculitis with perivascular inflammation composed of lymphocytes and histiocytes. Abdominal ultrasound and computed tomography of thorax, abdomen, and pelvis were negative. A presumptive diagnosis of rheumatoid arthritis with atypical features was made and a trial of treatment was started with 7.5 mg of prednisolone and 250 mg of d-penicillamine daily. The synovitis, oedema, and panniculitis improved but the nodules persisted. Over the next two years, at close review, the patient remained stable with treatment.

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“…A literature search revealed only seven patients (none reported in the radiologic literature) in which joint involvement was the initial manifestation of non-Hodgkin's lymphoma in adults [4,11]. Monarticular complaints were noted in four patients and polyarticular complaints in three.…”

Section: Discussionmentioning

confidence: 99%

Juxta-articular large cell lymphoma

et al. 1990

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Three patients with juxta-articular large cell lymphoma presented as suffering from monarthropathies. A spectrum of radiographic changes was observed that included subchondral sclerosis, regional osteopenia, effusion, and mottled lytic changes in the juxta-articular region of the affected joint. MRI was performed in two patients. In one, it revealed a high signal mass on T2-weighted sequences. In the second, a mass bridging the joint was demonstrated which was difficult to appreciate on CT and was not visible radiographically. In all cases, biopsies revealed large cell non-Hodgkin's lymphoma of bone. We present these studies to emphasize this unusual pattern of non-Hodgkin's lymphoma as well as to demonstrate the contribution of MRI to the diagnosis.

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Non‐hodgkin's lymphoma of the synovium simulating rheumatoid arthritis

Cited by 62 publications

References 27 publications

Large B cell lymphoma of the subtalar and talonavicular joint synovium

Large B cell lymphoma of the subtalar and talonavicular joint synovium

“Rheumatoid nodules” and lymphoma!

Juxta-articular large cell lymphoma

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