Primary bone lymphoma

Dr Owen Kang and Dr Henry Knipe et al.

Primary bone (skeletal/osseous) lymphoma (PBL) is a less common manifestation of lymphoma than secondary involvement from disseminated lymphoma. It is rare, accounting for <5% of bone tumours and <1% of non-Hodgkin lymphoma.

PBL is defined as the presence of lymphoma isolated to one bone without distant spread for six months after diagnosis. Multifocal PBL is less common and occurs with lymphoma is confined to two or more bones, again without distant spread for six months 1.

PBL can affect any age group, with peak incidence in (50-60) year-olds. It is rare in children <10 years old. There is a slight male predominance (M:F = 1.5:1) 2

Symptoms include localised pain and swelling, B-type symptomspathological fractures, and cord compression.

Diffuse large B cell lymphoma (DLBCL) is the most common subtype. The bony pelvis and femur are the most common locations 3.

Plain radiograph

PBL has non-specific features and the affected bone may be normal or affected by lytic, sclerotic or mixed pattern. The most common is a lytic pattern with permeative bone destruction and a wide zone of transition 1.

MRI

Associated soft tissue masses are common. Bone marrow changes include 2:

  • T1: low signal
  • T2: high signal

Five-year survival rate has been reported at ~ 80%, much better than other bone tumours 2.

For plain film presentation of permeative bone destruction consider 1:


Lymphoma
Bone tumours

The differential diagnosis for bone tumours is dependent on the age of the patient, with a very different set of differentials for the paediatric patient.

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Article Information

rID: 33182
Section: Pathology
Synonyms or Alternate Spellings:
  • Primary osseous lymphoma
  • Multifocal primary bone lymphoma
  • Primary bone lymphoma (PBL)
  • Reticulum cell sarcoma
  • Malignant lymphoma of the bone
  • Osteolymphoma

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