Non-Hodgkin's Lymphoma: An Unusual Cause of Shoulder Pain

Abstract

Shoulder pain is a common complaint seen in the orthopedic clinic. Here, we report a rare case of primary extranodal ileocecal with exceedingly rare right shoulder deltoid non-Hodgkin's lymphoma (NHL). A 67-year-old female presented with abdominal swelling for four months associated with loss of appetite, loss of weight, and night sweats. Abdominal contrast-enhanced CT and cecal biopsy confirmed the diagnosis of ileocecal NHL. A right hemicolectomy was performed, and the patient completed six cycles of chemotherapy. The patient developed right shoulder pain with swelling three months later and was diagnosed with a relapse ileocecal lymphoma with dissemination to the right deltoid muscle after a repeat positron emission tomography scan. Clinicians need to consider NHL as a differential diagnosis in evaluating shoulder pain or swelling even though it is exceedingly rare. A partial or non-response to chemotherapy with dissemination to skeletal muscle carries a poor prognosis.

Keywords: chemotherapy; extranodal; non-hodgkin’s lymphoma; shoulder pain; skeletal muscle lymphoma.

Figure 1. (A) PET scan showing evidence of active lymphoma in the cecum and abdominal and pelvic nodes with no metabolic activity over the right shoulder. (B) Three months later, a PET scan showing FDG hypermetabolism at the right deltoid region associated with FDG-avid active lymphoma in the abdomen and pelvis and a new soft-tissue mass at the right iliac fossa adjacent to the anastomosis site.

PET: positron emission tomography; FDG: fluorodeoxyglucose

Figure 2. (A) PET scan showing evidence of active lymphoma in the cecum and abdominal and pelvic nodes with no metabolic activity over the right shoulder. (B) Three months later, a PET scan showing FDG hypermetabolism at the right deltoid region associated with FDG-avid active lymphoma in the abdomen and pelvis.

PET: positron emission tomography; FDG: fluorodeoxyglucose