Large cell lymphoma of bone. A report of three cases of B-cell origin

Malignant Lymphomas of the Bone in Korea

Eleven cases of primary non-Hodgkin's lymphoma of the bone collected from several institutes in Seoul, Korea were histologically and immunologically reclassified accord ing to U.S. National Cancer Institute working formulation, and the results were com pared with those in Western countries and in one Asian country (Japan). No significant differences were found in sex or in the distribution of primary lymphomas of bone between Korea, Japan, or the Western countries. Six cases previously diagnosed as "histiocytic lymphoma" were reclassified as diffuse large cell type lymphoma according to the working formulation. Two cases were diffuse small cell type and three cases were diffuse mixed small and large cell type. B cell immunophenotype was shown in 10 of 11 cases and T cell type was exhibited in 1 case. Patients with stage IE tumors had a better prognosis than those with stage IV. Histologic grade according to the U.S. National Cancer Institute working formulation correlated with clinical stage. A tendency towards better prognosis with lower grade tumors was possible but not statistically significant. Int J Surg Pathol 2(3):187-192, 1995

Primary bone lymphoma

Primary bone lymphomas are rare, even though secondary involvement of the bone marrow is a common event in systemic lymphomas. Most primary bone lymphomas are primary bone diffuse large B-cell lymphomas (PBDLBCLs) with a rare occurrence of follicular, marginal zone, anaplastic large cell, Hodgkin, and T-cell lymphomas. The PBDLBCL affects the middle-aged to elderly population, with a slight predominance in men. The patients present with bone pain, palpable mass, fractures, or neurologic symptoms. The metaphysis of bones is a common location of PBDLBCL. Morphologically, the lymphoma consists of a polymorphous mixture of small to large cells with multilobated nuclei, fine chromatin, and inconspicuous to prominent nucleoli. Differential diagnoses for PBDLBCL include chronic osteomyelitis, primary bone sarcoma, leukemic infiltrate, Ewing sarcoma, metastatic sarcomas, and carcinoma. Most PBDLBCLs are treated with combined radiotherapy and chemotherapy with good prognosis.

Diffuse large B-cell lymphoma of bone: an analysis of differentiation-associated antigens with clinical correlation

Twenty-nine patients with diffuse large B-cell lymphomas presenting with bone involvement, including 18 localized primary bone lymphomas (group 1), 2 multifocal primary bone lymphomas (group 2), and 9 patients with extraskeletal disease at diagnosis (group 3), were studied. The tumors were subclassified according to the criteria of the WHO classification and evaluated by immunohistochemistry for expression of antigens associated with germinal center (GC) and non-GC stages of B-cell differentiation (bcl-6, CD10, MUM-1, VS38c, CD138, bcl-2, and CD44). The presence of a BCL-2/IgH gene rearrangement was investigated by polymerase chain reaction. All cases were characterized by similar clinicopathologic and morphologic features and had similarly good overall outcome. The patients (23 males, 6 females, median age 44 years) had tumors in long bones (14), axial skeleton (8), limb girdles (3), and multiple sites (4). Most tumors (24) were centroblastic, with multilobated cells in 12 cases. Almost half of the tumors (14 of 29, 48%) were bcl-6+CD10+ (GC-like), 9 of 29 cases (31%) were bcl-6+CD10- (indeterminate phenotype), and 6 of 29 cases (21%) were CD10-bcl-6- (post-GC like). The indeterminate phenotype was seen only in primary bone lymphoma. MUM-1 was frequently expressed in GC-like and non-GC-like categories. We found no evidence of plasmacytic differentiation by CD138, and VS38c immunoreactivity was distinctly rare (2 of 29 cases). CD44 was detected in 6 tumors, all CD10-. Bcl-2 was expressed by 70% of the tumors, but only 1 of 23 cases tested had a Bcl-2/JH rearrangement by polymerase chain reaction. A survival analysis showed that GC-like tumors had a longer overall survival duration compared with non-GC-like tumors (P = 0.0046). In conclusion, a GC-like immunophenotype characterizes roughly half of large B-cell lymphomas of bone and is associated with an improved survival.

Lymphomas of the bone: a pathological and clinical study of 54 cases

We examined 28 cases of primary bone lymphomas (PBL; stage IE) and 26 cases of systemic lymphomas involving the bone (SBL; stage IIE to IV). Two histologic types were prevalent: Diffuse large B-cell lymphomas (DLBCL; 26 PBL and 21 SBL) and CD30+ anaplastic large cell lymphomas (ALCL; 1 PBL and 4 SBL). A mature B phenotype (CD45+, CD20+, CD79a+, CDw75+/-, CD10-/+) was established in the DLBCL group. Bcl-2 immunoreactivity was demonstrated in 13/37 cases (35%), and bcl-6 immunostaining was observed in 22/32 cases (69%). ALCL showed null/T phenotype (CD3-/+; CD43+/-; CD30+), with ALK-1 expression in 3/3 cases. With use of a FR3A primer, a monoclonal pattern was demonstrated by PCR analysis in 22/41 lymphomas (54%). Bcl-2 translocation was identified in 2/41 cases (5%). This study details the clinical and pathological characteristics of bone lymphomas. Our immunohistochemical and molecular data suggest that most of them are "de novo" DLBCL and support their follicle center origin.

Primary bone lymphoma: report of an unusual case with a review of the literature

Primary bone lymphoma is uncommon and usually involves the long bones. We report a patient with involvement of a metacarpal bone, and review the literature.

Primary skeletal non-Hodgkin's lymphoma in the pediatric age group

The authors discuss rare primary skeletal non-Hodgkin's lymphoma in 16 patients treated from 1973 to 1989. The symptoms of these patients related to bone lesions in 95% of the cases. These bone lesions were monostotic or polyostotic, with or without regional and distant metastases. The locations of these lesions were long bones in 13 patients, pelvic bones in seven patients, and skull and vertebral bodies in two patients. The anatomical locations of these lesions in the bones were diaphysis alone in one patient, epiphysis in two patients, metaphysis in three patients, and a combination of diaphyseal, epiphyseal, and metaphyseal lesions in seven patients. Extraskeletal involvement was present in nine patients; extraskeletal sites included regional or distant lymph node involvement in seven cases, the mediastinum in two, lung nodules in two patients, the skin and subcutaneous regions in four patients; bone marrow in three patients, and peripheral nervous system (PNS) in one patient. Two patients had stage I disease, three had stage II disease, eight had stage III disease, and three had stage IV disease. The majority of patients had large noncleaved cell diffuse lymphomas or DHL by Rappaport classification. All patients were treated with the LSA2-L2 protocol; six patients received radiation therapy to the affected bone, and ten patients received no radiation therapy. Three patients failed on treatment within the first 4 months of therapy. Two patients developed a second tumor, one in the radiation therapy field and the other in a patient who received no radiation therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaplastic large cell Ki-1 lymphoma of bone

Anaplastic large cell Ki-1 lymphoma is an uncommon type of non-Hodgkin's lymphoma that rarely presents primarily in the bone. Three such cases are reported. All patients were young and had bone pain; one had paraparesis as a complication of collapse of the thoracic vertebral body. The involvement was either monostotic or polyostotic. Radiologically, the lesions were lytic and had ill-defined borders. Histologically, the large neoplastic cells had pleomorphic bizarre nuclei, prominent nucleoli, abundant deeply amphophilic cytoplasm, and paranuclear pale hof. They were admixed with variable numbers of inflammatory cells. One case each was of T-cell, B-cell, and non-T non-B lineage. All three cases showed excellent responses to chemotherapy with or without radiation therapy. Recognizing the lymphomatous nature of this highly pleomorphic tumor is important because of its potential curability with appropriate chemotherapy.

Primary lymphoma of bone: a clinicopathologic study of 25 cases reported over 10 years

Twenty-five cases of primary lymphoma of bone (PLB) reported over a 10-year period were reviewed. The presenting symptom was related to involvement of a single bone with or without regional nodal disease. None showed dissemination of lymphoma in the subsequent six months. Patients affected were 7-65 years of age. An equal predilection for the axial and appendicular skeleton was noted. Histologically, the commonest subtype was diffuse histiocytic lymphoma (DHL, 17 cases), whereas four were poorly differentiated lymphocytic (PDL) type and another four were unclassifiable. Follow-up was available in 18 out of 25 patients for periods ranging from 7 months to 8 years. On clinicopathologic correlation we found that 75% of disease-free patients had a DHL whereas 60% of those alive with disease had a PDL. This study reiterates the view that PLB has a good prognosis and the DHL subtype is especially amenable to complete eradication.

A case of primary osseous malignant immunoblastic B-cell lymphoma with intracytoplasmic mu lambda immunoglobulin inclusions

Primary malignant lymphoma of bone, so-called Parker-Jackson reticulosarcoma, is a rare form of extranodal lymphoma with a relatively good prognosis. It often corresponds to B-cell lymphoma of high-grade malignancy. We report a case of mu lambda immunoblastic lymphoma showing two distinctive features: an abundant reactive T-lymphocytic population and unusual intra-cytoplasmic inclusions. These inclusions were PAS positive and consisted of monotypic mu lambda immunoglobulin localized in peculiar aggregates of rough endoplasmic reticulum. Their morphological appearances resembled the well-documented inclusions described in some varieties of non-Hodgkin's lymphoma.