Unusual primary osseous Hodgkin’s lymphoma: A case report

Abstract

Hodgkin’s lymphoma (HL) is one of the few adult malignancies that most frequently presents with a progressive, painless enlargement of the peripheral lymph nodes. A primary osseous presentation of HL, without lymph node involvement, is extremely rare. The present study describes a case of primary multifocal osseous HL in a 22-year-old female. The patient presented with pain in the lumbar-sacral-pelvic area and a prolonged fever. Pathological examination led to a diagnosis of primary multifocal osseous lymphoma, and the patient was subsequently prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. Following this, the patient recovered with no pain or fever, and computed tomography identified no further progression. The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma. Furthermore, in rare cases, HL may even occur in combination with multiple myeloma. This makes it difficult to diagnose the condition, which often leads to a delay in treatment. Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

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)

“…In five of the papers reviewed, cortical bone involvement was defined as the finding of osteolytic, sclerotic, or mixed lesions on a conventional radiograph; in a sixth paper, histopathologic confirmation of a radiographic finding was required . Common misdiagnoses included benign lesions, such as osteomyelitis and tuberculosis, as well as metastases from non‐lymphomatous malignant neoplasms such as leukemia, neuroblastoma, or Langerhans cell histiocytosis .…”

“…In five of the papers reviewed, cortical bone involvement was defined as the finding of osteolytic, sclerotic, or mixed lesions on a conventional radiograph 10,12,[28][29][30] ; in a sixth paper, histopathologic confirmation of a radiographic finding was required. 31 Common misdiagnoses included benign lesions, such as osteomyelitis and tuberculosis, as well as metastases from non-lymphomatous malignant neoplasms such as leukemia, neuroblastoma, or Langerhans cell histiocytosis. 8,9 Histologic staining for evidence of HL in a biopsied lesion was required in seven of the studies, [6][7][8][32][33][34][35] whereas one study required confirmation of bone histology concordant with a lymph node biopsy.…”

“…The most frequently used regimen (n = 10) was adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). 6,9,13,31,33,34,37,38 Ten patients received chemotherapy alone, 7,9,13,29,31,33,34,37,38,43 whereas six received combined modality treatment with chemotherapy and radiation. 6,13,15,32,33 One report did not mention the treatment used, nor did it comment on survival.…”

Classic Hodgkin lymphoma in pelvis

“…It seems that primary bone HL most likely appears on spine or long bone, seldom occurs in pelvic (Table 2 ). [ 5 , 6 , 8 , 13 , 19 – 33 ] Nodular sclerosis CHL represents 70% of CHL in Europe and USA, and this figure in China is 32.6%. [ 34 ] Almost 54% of nodular sclerosis CHL cases present with a huge soft mass.…”