Kennedy Grace, Weir Phil, Johnston Kevin, Elder Patrick
Department of Haematology, Altnagelvin Area Hospital, Glenshane Road, Londonderry, Co. Londonderry, Ireland.
Case Rep Orthop. 2019 Mar 3;2019:3174768. doi: 10.1155/2019/3174768. eCollection 2019.
Primary bone lymphoma (PBL) is a rare bone malignancy which may present with atraumatic pain, swelling, or pathological fracture. Whilst the femur is the most commonly affected site, any bone may be involved. PBL should be distinguished from other bone lesions to determine clinical management.
We report the case of an 89-year-old gentleman who presented to the local emergency department with atraumatic hip pain and inability to weight-bear. Multimodal imaging showed evidence of a tumor involving the proximal femur and adjacent acetabulum with an associated pathological intertrochanteric fracture. Biopsy specimens demonstrated this to be PBL of the diffuse large B-cell subtype. No other disease foci or nodal involvement was identified. The patient underwent proximal femoral replacement and acetabular reconstruction prior to commencing R-Mini-CHOP chemotherapy, during which time he has been permitted to fully weight-bear.
To our knowledge, this is the first reported case of a patient having PBL with both femoral and acetabular involvements. Due to its infrequent occurrence, evidence remains limited to advise therapeutic guidelines. Our practice concurs with literature suggesting that surgery be reserved for cases of pathological fracture. However, the merits of undergoing surgical fixation prior to chemoradiation treatment have been considered.
原发性骨淋巴瘤（PBL）是一种罕见的骨恶性肿瘤，可能表现为无创伤性疼痛、肿胀或病理性骨折。虽然股骨是最常受累的部位，但任何骨骼都可能被累及。PBL应与其他骨病变相鉴别，以确定临床治疗方案。
我们报告一例89岁男性患者，因无创伤性髋部疼痛和无法负重就诊于当地急诊科。多模态影像学检查显示股骨近端和相邻髋臼有肿瘤迹象，并伴有病理性粗隆间骨折。活检标本显示为弥漫性大B细胞亚型的PBL。未发现其他疾病病灶或淋巴结受累。患者在开始R-Mini-CHOP化疗前接受了股骨近端置换和髋臼重建，在此期间他被允许完全负重。
据我们所知，这是首例报道的同时累及股骨和髋臼的PBL患者。由于其发病率低，用于指导治疗的证据仍然有限。我们的做法与文献一致，即建议对病理性骨折病例进行手术治疗。然而，也考虑了在放化疗前进行手术固定的益处。
