Primary Lymphoma of the Calcaneus: A Case Report

Abstract

Introduction: Primary Non-Hodgkin's lymphoma (NHL) of the bone is a rare condition. Calcaneus is also an uncommon site for this kind of lymphoma. Case Presentation: We hereby present a case of primary non-Hodgkin's lymphoma of the calcaneus, which was diagnosed and treated at our hospital. The patient had a minor twisting trauma of his ankle but symptoms were present for one year after trauma. The patient complained from instability and swelling of his ankle. After paraclinic assessments, a pathologic lesion was detected in his calcaneus, so incisional biopsy was done and the pathology diagnosis was a large B-cell non-Hodgkin's lymphoma. Bone marrow assessment was negative for the disease. The patient was treated by chemotherapy and radiotherapy and currently the disease is in remission and patient is doing his previous full activity without any important complication. Conclusions: Lymphoma is a rare condition in the foot region but we suggest to be more wise for chronic, uncommon symptoms after minor injuries, as lymphoma of the bone can present mysterious and nonspecific symptoms as was seen in this patient. It may be better to do more assessments to prevent delayed diagnosis of such rare conditions. These rare cases may have atypical imaging and clinical appearance, which can lead to misdiagnosis.

Chronic Heel Pain Found to Be Diffuse Large B-cell Lymphoma of the Calcaneus

“…Upon review, the treatment regimens utilized in the management of calcaneal PLB have varied, using a combination of the two aforementioned treatment modalities. One patient underwent six cycles of chemotherapy without radiation therapy [ 8 ], others had cycles of chemotherapy followed by radiotherapy [ 7 , 9 , 12 ], and two more, including our patient, had localized radiation treatments only [ 10 ]. This variety highlights the need to take into account individual clinical scenarios when coming up with a treatment plan.…”

Primary tumours of the calcaneus (Review)

“…The symptoms vary from mild non-specific pain to soft tissue swelling, often with a lack of constitutional symptoms ( 96 – 98 ). A number of cases may be accompanied by a pathological fracture ( 95 , 96 , 98 ). A physical examination of the affected hind foot may reveal non-pitting oedema, reddening and tenderness ( 97 , 99 ).…”

“…Radiographs reveal a mixture of osteolysis and sclerotic lesions of the calcaneus, which produce a ‘moth-eaten’ and patchy appearance ( 96 – 98 , 101 ). Periosteal reaction, pathologic fracture and soft tissue involvement may additionally be observed ( 99 , 100 ).…”

“…Although patients experience anaemia and fatigue with chemotherapy, it is effective to be disease free for >5 years ( 98 ). Radiation therapy is recommended following chemotherapy ( 96 – 98 , 101 ). Primary osseous lymphoma has provided a good prognosis, except in one patient (Enneking stage III) with a recurrent lesion in the contralateral distal tibia ( 100 ).…”

“…Primary osseous lymphoma has provided a good prognosis, except in one patient (Enneking stage III) with a recurrent lesion in the contralateral distal tibia ( 100 ). A majority of patients respond well to the treatment and present without local or metastatic disease during long-term follow-up ( 96 – 98 , 101 ).…”