Zekry Karem M, Yamamoto Norio, Hayashi Katsuhiro, Takeuchi Akihiko, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minia, Egypt.
J Orthop Case Rep. 2017 Nov-Dec;7(6):6-9. doi: 10.13107/jocr.2250-0685.924.
Primary lymphoma of the bone (PLB) is uncommon clinical entity with the vast majority of the cases are non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of PLB.
We report a case of 60-year-old female presented with pain in the right hip that persisted for 2 months. Plain X-ray, computed tomography, and magnetic resonance imaging of the right hip showed a lytic lesion involving the right acetabulum and adjoining iliac bone with extraosseous mass. The histopathological and immunohistochemical examination confirmed a diagnosis of DLBCL. Treatment with cyclophosphamide, epirubicin, vincristine, and prednisone plus rituximabestablished a complete response (CR) with remodeling of the acetabulum. At the last follow-up, the patient had the ability to walk without any support which obviates the need of primary surgical interference for the tumor.
The PLB must be considered in the differential diagnosis of lytic lesions involving the pelvic bones in older adults, especially when accompanied by extraosseous soft tissue mass. Our patient of PLB showed goodremodeling of the acetabular area after CR to chemotherapy without primary surgical interference for the tumor with the limitation of weight-bearing during chemotherapy treatment to prevent fracture.
原发性骨淋巴瘤（PLB）是一种罕见的临床实体，绝大多数病例为非霍奇金淋巴瘤。弥漫性大B细胞淋巴瘤（DLBCL）是PLB最常见的亚型。
我们报告一例60岁女性，因右髋部疼痛持续2个月就诊。右髋部的X线平片、计算机断层扫描和磁共振成像显示一个溶骨性病变，累及右髋臼和相邻的髂骨，并伴有骨外肿块。组织病理学和免疫组织化学检查确诊为DLBCL。采用环磷酰胺、表柔比星、长春新碱、泼尼松联合利妥昔单抗治疗后获得完全缓解（CR），髋臼重塑。在最后一次随访时，患者能够在无任何支撑的情况下行走，从而避免了对肿瘤进行初次手术干预。
在老年患者中，尤其是伴有骨外软组织肿块的情况下，对于累及骨盆骨的溶骨性病变进行鉴别诊断时必须考虑PLB。我们的PLB患者在化疗获得CR后髋臼区域显示出良好的重塑，无需对肿瘤进行初次手术干预，但在化疗期间需限制负重以防止骨折。
