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.
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.
Associated soft tissue masses are common. Bone marrow changes include 2:
- T1: low signal
- T2: high signal
Treatment and prognosis
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:
- 1. Lim CY, Ong KO. Imaging of musculoskeletal lymphoma. Cancer Imaging. 2013;13 (4): 448-57. doi:10.1102/1470-7330.2013.0036 - Free text at pubmed - Pubmed citation
- 2. Krishnan A, Shirkhoda A, Tehranzadeh J et-al. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics. 2003;23 (6): 1371-83. doi:10.1148/rg.236025056 - Pubmed citation
- 3. Maruyama D, Watanabe T, Beppu Y et-al. Primary bone lymphoma: a new and detailed characterization of 28 patients in a single-institution study. Jpn. J. Clin. Oncol. 2007;37 (3): 216-23. doi:10.1093/jjco/hym007 - Pubmed citation
- overview of lymphoma
WHO classification of tumours of haematopoietic and lymphoid tissues
- Hodgkin lymphoma
- mature B-cell lymphoma
- mature T-cell and NK-cell lymphoma
- post-transplant lymphoproliferative/lymphoproliferation disorders
- location-specific lymphomas
- central nervous system
- head and neck lymphoma
- thoracic lymphoma
- gastrointestinal lymphoma
- hepatobiliary lymphoma
- genitourinary lymphoma
- musculoskeletal lymphoma
- cutaneous lymphoma
- lymphoma staging
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.
- bone-forming tumours
- cartilage-forming tumours
- chondromyxoid fibroma
- fibrous bone lesions
- bone marrow tumours
- other bone tumours or tumour-like lesions
- aneurysmal bone cyst
- benign fibrous histiocytoma
- giant cell tumour of bone
- Gorham massive osteolysis
- haemophilic pseudotumour
- intradiploic epidermoid cyst
- intraosseous lipoma
- musculoskeletal angiosarcoma
- musculoskeletal haemangiopericytoma
- primary intraosseous haemangioma
- post-traumatic cystic bone lesion
- simple bone cyst
- impending fracture risk