Hodgkin lymphoma (musculoskeletal manifestations)

Last revised by Bruno Di Muzio on 17 Jan 2024

Musculoskeletal manifestations of Hodgkin lymphoma (HL) are radiographically evident in 10-25% of cases at some point during the disease course. The majority of early bone lesions are lytic, however, blastic lesions are common (up to 45%). 

For a general discussion on the disease, please refer to the main Hodgkin lymphoma article.

Pathology

Osseous involvement may occur via hematogenous or lymphatic spread, with direct extension from an adjacent lymph node being the most common route, carrying a better prognosis than hematogenous spread. 

Location

Any skeletal site may be involved, however, the most common regions include the spine, pelvis, ribs, femur, and sternum. 

  • spine: most commonly involved site in Hodgkin lymphoma

    • erosion of anterior or anterolateral aspect of the vertebral body(ies) is a classic finding in HL, caused by enlarged paravertebral lymph nodes

    • nodular sclerosing HL shows diffusely increased density with our without anterior erosion; vertebral body height is unaffected

    • single, dense vertebra (ivory vertebra) in adults is suggestive of HL, however, it has many other causes

    • intervertebral disc spaces are generally unaffected by the disease

  • pelvis: mixed or sclerosing type predominates

  • ribs: may be osteolytic and expansile

  • sternum

  • long bones:  frequently lytic, extending along the long axis of bone through the medullary cavity with endosteal scalloping of the cortex

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