Unusual primary osseous Hodgkin's lymphoma: A case report

Abstract

Hodgkin's lymphoma (HL) is one of the few adult malignancies that most frequently presents with a progressive, painless enlargement of the peripheral lymph nodes. A primary osseous presentation of HL, without lymph node involvement, is extremely rare. The present study describes a case of primary multifocal osseous HL in a 22-year-old female. The patient presented with pain in the lumbar-sacral-pelvic area and a prolonged fever. Pathological examination led to a diagnosis of primary multifocal osseous lymphoma, and the patient was subsequently prescribed a course of Adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) chemotherapy. Following this, the patient recovered with no pain or fever, and computed tomography identified no further progression. The clinical, radiological and histological features of HL are similar to those of other medical conditions, such as tuberculosis and eosinophilic granuloma. Furthermore, in rare cases, HL may even occur in combination with multiple myeloma. This makes it difficult to diagnose the condition, which often leads to a delay in treatment. Clinicians should not ignore HL when it manifests in the unusual primary osseous form.

Keywords: Hodgkin’s lymphoma; bone; diagnosis.

Figure 1

Pelvic X-ray film revealing a bone lesion (white arrows) in each sacroiliac joint and in the inferior segment of the lumbar spine. The left greater trochanter is not visible.

Figure 2

Computed tomography of the abdominal region and pelvis revealing severe osteolysis (arrows) around each sacroiliac joint and the left greater trochanter. However, no extraosseous involvement was visible, such as in the retroperitoneal and hepatic portal lymph nodes. (A) Horizontal position, (B) coronary position and (C and D) three-dimensional reconstructional views.

Figure 3

Single-photon emission computed tomography (CT) revealing abnormal bone metabolism of the lumbar, sacroiliac joint, the left greater trochanter and the left shoulder. CT of the lung and mediastinum reveals no abnormalities, except for sclerotin destruction in the left shoulder. (A) Front view and (B) rear view.

Figure 4

Biopsy sample demonstrating that cells with the typical morphology of Reed-Sternberg (RS) cells, with abundant cytoplasm and prominent eosinophilic nucleoli, were scattered against a background of reactive inflammation. Immunohistochemistry staining of the RS population confirmed the expression of paired box protein-5 and cluster of differentiation (CD)30 and CD15.