Primary lymphoma of bone originating in a rib

Abstract

Malignant lymphoma originating in the bone is rare and is now recognized as being an independent clinicopathologic entity known as primary lymphoma of bone. A 60-year-old man complaining of right chest and back pain consulted our hospital for further examination. Chest X-ray and computed tomogram revealed osteolysis and a surrounding soft tissue mass in the sixth right rib. An ultrasonically-guided needle biopsy of the tumor was performed, and histologic examination indicated the dense proliferation of similar-sized atypical cells with nucleoli and an irregular nuclear border. A diagnosis of diffuse, medium-sized non-Hodgkin's lymphoma, B-cell type was made. En block resection of the tumor and chest wall was performed. Macroscopically, the tumor measured 7.5 x 4.8 x 3.0 cm in diameter, and the histologic findings were similar to those of the preoperative needle biopsy. Unfortunately, postoperative treatment with radiation therapy and chemotherapy was ultimately unsuccessful, and a local recurrence and metastatic lesions appeared in the stomach and para-aortic abdominal lymph nodes 7 months after the first symptom appeared. The patient died 3 months later. Surgery was chosen as the initial therapy as it was considered that a rib resection would not result in serious respiratory compromise and the complete resection of the tumor would be superior to radiation therapy for local control. Some authors have reported that the surgical resection of a primary lymphoma of the bone originating in a rib can yield a good prognosis. However, it is a systemic disease and a more effective therapeutic strategy should be developed.

Multidetector CT for Evaluation of the Extrapleural Space

“…Malignant lymphoma originating in the bone is rare and can be seen as a lytic bone lesion with or without cortical invasion or extension into the contiguous soft tissues. Thus, this malignancy can invade the extrapleural fat (66). Treatment of lymphoma depends on the histologic subtype determined after biopsy.…”

Chest wall lymphomas: Fine needle aspiration cytodiagnosis and review of the literature

“…Review of literature corresponding to our 15‐year study period (2000‐2015) revealed 20 reports based either on cases series or isolated cases (Table ) in which 26 histologically confirmed chest wall lymphoma cases were described . Location of the swellings was the anterior chest wall/manubrium in 14 cases, left chest wall (four cases), right chest wall (three cases), lateral chest wall (NOS in two cases), back in one case and rib/chest wall swellings and NOS in two cases.…”

Primary chest wall lymphoma with no history of tuberculous pyothorax: Diagnosis and treatment

“…Primary lymphoma of the bone (PLB), which was first reported by Oberling, 12 now is recognized as an independent clinicophathologic entity. 4,13 PLB accounts for approximately 4.7% of extranodal lymphomas. 14 The majority of cases occur in long bones, pelvis, or spine, and rib involvement is rare (2% to 15% of cases of PLB).…”

“…14 The majority of cases occur in long bones, pelvis, or spine, and rib involvement is rare (2% to 15% of cases of PLB). 4,13 The mean age at presentation for PLB, according to a review by Ostrowski and associates, 15 was 46 years with male predominance. The most frequent symptoms are pain, swelling, and B symptoms (fever, night sweats, and body weight loss), as in other lymphoma conditions.…”

“…To date, only a few cases of primary malignant lymphoma arising from the pleura or the rib with no history of tuberculous pyothorax and artificial pneumothorax therapy have been reported, most of which occurred in Japan. 3,4 Treatment of primary chest wall lymphoma was not clear and various treatment strategies were considered. Surgery followed by adjuvant chemotherapy can provide a satisfactory outcome in patients in whom the chest wall lymphoma is the only site of disease.…”