Multiple osteolytic lesions due to Double-Expressor Primary non-Hodgkin Lymphoma of the Bone

Primary non-Hodgkin lymphoma of the bone (PLB) is a rare type of non-Hodgkin’s lymphoma (NHL) that affects the skeletal system with or without regional lymph node involvement. We present the case of a 74-year-old female patient with pain due to multifocal osteolytic lesions. The diagnosis of diffuse large B-cells (non-GCB) phenotype was made by clinical, laboratory, histopathological examination accompanied by an extensive immunohistochemical profile of one of the skeletal lesions.

Keywords
Lymphoma, Non-Hodgkin; Osteolysis; Positron Emission Tomography Computed Tomography, Immunohistochemistry

Authorship

Sotirios Papageorgiou

University General Hospital “Attikon”, Second Department of Internal Medicine, Propaedeutic and Research Unit. Haidari, Greece.University General Hospital “Attikon”GreeceHaidari, GreeceUniversity General Hospital “Attikon”, Second Department of Internal Medicine, Propaedeutic and Research Unit. Haidari, Greece.

https://orcid.org/0000-0002-3376-837X

Theodoros Katsikas

General and Oncology Hospital of Kifissia “Agioi Anargyroi”, Second Department of Internal Medicine. Athens, Greece.General and Oncology Hospital of KifissiaGreeceAthens, GreeceGeneral and Oncology Hospital of Kifissia “Agioi Anargyroi”, Second Department of Internal Medicine. Athens, Greece.

https://orcid.org/0000-0002-6487-3164

Panagiota Voukelatou

https://orcid.org/0000-0002-4505-5879

Ioannis Vrettos

https://orcid.org/0000-0003-4639-2460

Asimina Papanikolaou

“Evagelismos General Hospital”, Hematopathology Department. Athens, Greece.“Evagelismos General HospitalGreeceAthens, Greece“Evagelismos General Hospital”, Hematopathology Department. Athens, Greece.

https://orcid.org/0000-0002-4911-5111

Anthi Bouchla

https://orcid.org/0000-0002-9234-7073

Vasiliki Pappa

https://orcid.org/0000-0003-0421-9424

Andreas Kalliakmanis

https://orcid.org/0000-0001-7250-2841

Authors’ contributions: Katsikas T, Vrettos I, Voukelatou P and Kalliakmanis A were responsible for the initial patient’s medical care. Papanikolaou A was the pathologist in charge of the case, provided the microscopic images and wrote this topic of the article. Papageorgiou S, Bouchla A, and Pappa V were the hematologists in charge of the post-diagnosis treatment. Katsikas T, Vrettos I and Voukelatou P. performed the initial workup of the case under the supervision of Kalliakmanis A, Papageorgiou S and Katsikas T wrote the manuscript. All authors collectively proofread and approved the final version for publication.

Conflict of interest: None

Correspondence Theodoros Katsikas 2nd Department of Internal Medicine - General and Oncology Hospital of Kifissia “Agioi Anargyroi” Noufaron and Timiou Stavrou, 14, 14564 – Athens – Greece Phone: +55 (69) 4827-9936 katsikastheodoros@gmail.com

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (7)

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Figure 1
Plain X-Ray of the right foot. Fibula’s infiltrative bone destruction.

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Figure 2
MRI of the right foot. T2-weighed images showing abnormal signals involving tibia, fibula, talus and metatarsal bones.

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Figure 3
18F-FDG PET/CT imaging demonstrating high FDG uptake in the majority of scanned bones. Cranial and long bones of arms and legs are more severely affected, with soft tissue masses accompanying the bone lesions.

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Figure 4
Photomicrographs of the bone biopsy. A – Diffuse infiltration of bone by a large cell lymphoma (H&E, X100); B – Higher magnification of the cell infiltrate (H&E, X200).

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Figure 5
Photomicrographs of the bone biopsy. A – CD20 (X200) expressed by lymphoma cells; B – BCL2(X200) positive expression; C – BCL-6 (X200) positive; D – MUM1 (X200) positive.

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Figure 6
Photomicrographs of the bone biopsy. A – CD10(X200) negative; B – In situ hybridization (EBER) for EBV (X200), negative.

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Figure 7
Photomicrographs of the bone biopsy. A – CIgM(X400) positive; B – CIgκ (X400) positive; C – MYC (X400) > 40%; D – High rate of proliferation MIB1 (X200) overall ~90%.

Figure 1 Plain X-Ray of the right foot. Fibula’s infiltrative bone destruction.

Figure 2 MRI of the right foot. T2-weighed images showing abnormal signals involving tibia, fibula, talus and metatarsal bones.

Figure 3 18F-FDG PET/CT imaging demonstrating high FDG uptake in the majority of scanned bones. Cranial and long bones of arms and legs are more severely affected, with soft tissue masses accompanying the bone lesions.

Figure 4 Photomicrographs of the bone biopsy. A – Diffuse infiltration of bone by a large cell lymphoma (H&E, X100); B – Higher magnification of the cell infiltrate (H&E, X200).

Figure 5 Photomicrographs of the bone biopsy. A – CD20 (X200) expressed by lymphoma cells; B – BCL2(X200) positive expression; C – BCL-6 (X200) positive; D – MUM1 (X200) positive.

Figure 6 Photomicrographs of the bone biopsy. A – CD10(X200) negative; B – In situ hybridization (EBER) for EBV (X200), negative.

Figure 7 Photomicrographs of the bone biopsy. A – CIgM(X400) positive; B – CIgκ (X400) positive; C – MYC (X400) > 40%; D – High rate of proliferation MIB1 (X200) overall ~90%.

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Multiple osteolytic lesions due to Double-Expressor Primary non-Hodgkin Lymphoma of the Bone

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[1] Authors’ contributions: Katsikas T, Vrettos I, Voukelatou P and Kalliakmanis A were responsible for the initial patient’s medical care. Papanikolaou A was the pathologist in charge of the case, provided the microscopic images and wrote this topic of the article. Papageorgiou S, Bouchla A, and Pappa V were the hematologists in charge of the post-diagnosis treatment. Katsikas T, Vrettos I and Voukelatou P. performed the initial workup of the case under the supervision of Kalliakmanis A, Papageorgiou S and Katsikas T wrote the manuscript. All authors collectively proofread and approved the final version for publication.