Osseous involvement in pediatric Hodgkin’s lymphoma

Abstract

Presented here is a report of 3 children, out of 66 total pediatric Hodgkin's lymphoma (HL) patients (4.5%) with bone involvement over a 3 and a half year period. Two patients presented with osseous lesions at the time of relapse and one had concurrent evidence of non-osseous disease. The clinical presentation, radiographic findings, histology, treatment and outcome of these patients are discussed. Boys and girls are nearly equally affected, local bone pain is the commonest symptom and B-symptoms are common. Vertebrae and pelvis are most frequently involved, commonly with an osteolytic picture. Nodular sclerosis is the predominant histological subtype. Most children received combined modality treatment and the overall response and survival are good.

Definition of cortical bone involvement in the staging of newly diagnosed pediatric Hodgkin lymphoma: A report from the International Working Group on Staging Evaluation and Response Criteria Harmonization (SEARCH)

“…These studies included 19 patients, who ranged in age from 6 to 68 years. Seven of these patients were within the pediatric age range . Of the 19 patients reported, 11 had multiple bone lesions, whereas 8 patients had single lesion disease.…”

“…Histologic staining for evidence of HL in a biopsied lesion was required in seven of the studies, whereas one study required confirmation of bone histology concordant with a lymph node biopsy . In another report, plain film findings with increased radionucleotide tracer uptake on Tc‐99m bone scan or histologic examination met the criteria for involvement, but CT evidence alone was considered sufficient in three other papers . In an additional three reports, CT evidence required histopathologic confirmation from a biopsy, whereas one study used MRI findings alone .…”

“…The most frequently used regimen ( n = 10) was adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) . Ten patients received chemotherapy alone, whereas six received combined modality treatment with chemotherapy and radiation . One report did not mention the treatment used, nor did it comment on survival .…”

“…Historically, cortical bone involvement has been associated with advanced disease, without necessarily portending an adverse outcome when multimodality therapy is used . Occurring with a frequency of between 9% and 35% at diagnosis in adults, these lesions have a heterogeneous appearance on imaging and include lytic, sclerotic, and mixed lesions . Cortical bone involvement is most frequent in the spine and pelvis, and the lesions are often ill‐defined, with cortical destruction and periosteal reaction …”

Hodgkin Lymphoma Presenting with Multifocal Osseous Lesions in a Child

“…Multiple bone lesions in disseminated HL in adults are well described but osseous lesions, as the presenting feature in children, is distinctly uncommon [6]. A recent review described only 23 cases of pediatric HL in English literature between 1968 and 2008 [7].…”