Volume 5, Number 33; April 24, 2006
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Volume 5, Number 33; April 24, 2006 |
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57-year-old caucasian female with swollen knee.
Recommended reading:
Routine bone scintigraphy is of limited value in the clinical assessment of untreated patients with Hodgkin's disease.
Four cases of metastatic lymphoma into the temporal bone.
Temporal bone pathology of metastatic T-cell lymphoma.
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Patient: 57 year old caucasian female with 1 year of monoarthritis, presenting with very swollen left knee, progressively worsening over 6 months. A large mass at the left knee could be palpated. Patient's labwork indicated anemia of chronic disease. PET scan detected a 7x7cm mass in the left knee. Biopsy revealed undifferentiated large B-cell lymphoma.
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Session Handout:
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Clinical Question: 1) What types of lymphoma will metastasize to bone sites, and which sites are more typical?
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Readings:
Link Directly to Fulltext article in Ovid Link Directly to Fulltext Article at Publisher Link Directly to Fulltext Article at Science Direct Fulltext Available in MDConsult using Journal Search and the search term: 98269609 Fulltext Available in EBSCOHost Academic Search Premier Link Directly to Fulltext Article Free on the Internet
Link Directly to Fulltext article in Ovid <2> Unique Identifier [PMID]: 15827414 Authors: Wong CL. Mansberg R. Yosufzai M. Institution: Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Camperdown, Australia. Title: Symmetric bony involvement of the lower extremities with lymphoma demonstrated on gallium scintigraphy.
Source: Clinical Nuclear Medicine. 30(5):353-5, 2005 May. Abstract: Primary or secondary lymphoma of the bone is uncommon. The sites of bony involvement include, in decreasing order of frequency, the spine, long bones, pelvis, ribs, and skull. A 66-year-old man with an atypical lineage of B-cell non-Hodgkin lymphoma is presented. The unusual initial presentation of the lymphoma included symmetric bony involvement of bilateral tibiae and the distal right femur, demonstrated on gallium-67 scintigraphy. The patient subsequently demonstrated resolution of the gallium-avid disease after treatment with fludarabine, cyclosporine, and ATG. This case also demonstrates the limitations of plain radiograph and the usefulness of MRI in the diagnosis of bony lymphoma. Publication Type: Case Reports. Journal Article.
<6> Unique Identifier [PMID]: 10962526 Authors: Landgren O. Axdorph U. Jacobsson H. Johansson B. Grimfors G. Bjorkholm M. Institution: Department of Medicine, Division of Hematology, Karolinska Institute and Hospital, Stockholm, Sweden. Title: Routine bone scintigraphy is of limited value in the clinical assessment of untreated patients with Hodgkin's disease.
Source: Medical Oncology. 17(3):174-8, 2000 Aug. Abstract: The aim of this retrospective study was to evaluate the role of routinely performed bone scintigraphy in the clinical assessment of patients with previously untreated Hodgkin's disease (HD). One-hundred and eighty-three patients with a median age of 31 yrs (range 16-85) with newly diagnosed HD underwent bone scintigraphy between 1972 and 1995. Bone scintigraphies and skeletal X-ray examinations of patients with any pathological scintigraphic finding were reassessed. Initially HD bone involvement could be excluded in 173 (95%) of the patients. Among the remaining ten patients, two had diffuse increased tracer uptake but X-rays were normal. One of these patients was classified as normal with regard to HD bone involvement. A bone marrow scintigraphy examination and regression of changes following therapy supported primary osseous involvement in the other patient. Five patients had focal scintigraphic abnormalities but skeletal X-rays remained negative; three of these five patients reported pain in the scintigraphically affected areas, and therefore the suspicion of bone involvement was strong. The remaining three patients had focal findings both on bone scintigraphy and skeletal X-ray examination and were considered as having osseous HD involvement. All seven patients judged to have HD bone involvement were planned to receive combination chemotherapy up-front, irrespective of the scintigraphic findings. In this series of 183 patients bone involvement was detected in seven patients based on bone scintigraphy/symptoms (n=3), bone marrow scintigraphy/symptoms (n=1), and bone scintigraphy/X-ray examination (n=3). The decision to give multiagent chemotherapy to all patients was not influenced by scintigraphic findings. Therefore, routine bone scintigraphy seems to be of limited value in the clinical assessment of untreated patients with HD. Publication Type: Evaluation Studies. Journal Article.
<9> Unique Identifier [PMID]: 1514944 Authors: Okamura H. Ohtani I. Nakamura N. Abe M. Wakasa H. Institution: Department of Otolaryngology, Fukushima Medical College, Japan. Title: Four cases of metastatic lymphoma into the temporal bone.
Source: Auris, Nasus, Larynx. 19(1):29-35, 1992. Abstract: A histopathological study on 17 temporal bones obtained from 9 patients who died of malignant lymphoma revealed metastasis of malignant lymphoma in 7 temporal bones from 4 of them. There were no differences in stages at the initial diagnosis between the cases with metastasis and those without metastasis. However, the higher was the frequency of metastasis, the longer became the period from the first medical examination to death. In addition, malignant lymphoma was considered to metastasize into the temporal bone by the following two routes, 1) direct infiltration or invasion from the cerebrospinal fluid and 2) hematogenous metastasis or invasion. Publication Type: Journal Article.
<10> Unique Identifier [PMID]: 3055803 Authors: Kobayashi K. Igarashi M. McBride RA. Saito R. Kataura A. Institution: Department of Otolaryngology, Sapporo Medical College, Japan. Title: Temporal bone pathology of metastatic T-cell lymphoma. [Review] [12 refs]
Source: Acta Oto-Laryngologica Supplement. 447:113-9, 1988. Abstract: Metastatic lymphoma involving the temporal bone is a rare tumour. A review of the English literature revealed only 13 reported cases. The common metastatic sites within the temporal bone are bone marrow and the internal auditory canal (IAC). Non-Hodgkin lymphoma has a tendency to infiltrate to the inner ear and middle ear, with bone marrow involvement. Recent advances in immunology have redefined the malignant lymphoma as a neoplasm of the immune system that has involved T and B cells. We present a case of non-Hodgkin T-cell lymphoma that metastasized to the temporal bone and central nervous system. [References: 12] Publication Type: Case Reports. Journal Article. Review.
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2005 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron MD
Contact:
Karl Woodworth
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