Bhakta Pooja, Hunzeker Zachary E, Garcia Juan D, Youssef Ayman, Grant Bradley J, Alfattal Rasha, Weaver Dylan, Bhargava Peeyush, Rischall Ariel, Musunuru Tejo, Muthukumarana Palawinnage V, Mallick Jayati, Lyapichev Kirill A
Department of Internal Medicine, John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States.
John Sealy School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, United States.
Front Oncol. 2023 Mar 16;13:1100559. doi: 10.3389/fonc.2023.1100559. eCollection 2023.
Primary bone lymphoma (PBL) is a rare extranodal presentation within lymphomas and primary bone malignancies. Pathologic fracture (PF) is a common complication of metastatic bone disease but is, rarely, the presentation of a primary bone tumor. We report a case of an 83-year-old man with a history of untreated prostate cancer, presenting with atraumatic fracture of his left femur after months of intermittent pains and weight loss. Radiographic workup revealed a lytic lesion suspicious for PF secondary to metastatic prostate cancer; however, initial core biopsy results were inconclusive for malignancy. A complete blood count with differential and complete metabolic panel was within normal limits. During surgical fixation and nailing of the femur, a reaming biopsy was performed as a repeat measure and revealed diffuse large B-cell lymphoma. Staging with positron emission tomography and computed tomography found no evidence of lymphatic or visceral involvement and chemotherapy was promptly initiated. This case highlights the diagnostic workup challenges for PF secondary to PBL, especially in the setting of concurrent malignancy. Because of the non-specific presentation of a lytic lesion on imaging associated with atraumatic fracture, we highlight PBL as an important diagnostic consideration.
原发性骨淋巴瘤（PBL）是淋巴瘤和原发性骨恶性肿瘤中一种罕见的结外表现形式。病理性骨折（PF）是转移性骨病的常见并发症，但很少是原发性骨肿瘤的表现形式。我们报告一例83岁男性病例，该患者有未治疗的前列腺癌病史，在经历数月间歇性疼痛和体重减轻后，出现左股骨无创伤性骨折。影像学检查发现一个溶骨性病变，怀疑是转移性前列腺癌继发的病理性骨折；然而，最初的核心活检结果无法确诊是否为恶性肿瘤。全血细胞计数及分类和全套代谢检查均在正常范围内。在对股骨进行手术固定和打钉过程中，再次进行了扩孔活检，结果显示为弥漫性大B细胞淋巴瘤。正电子发射断层扫描和计算机断层扫描分期检查未发现有淋巴或内脏受累的证据，于是立即开始化疗。该病例突出了PBL继发病理性骨折的诊断检查挑战，尤其是在合并恶性肿瘤的情况下。由于与无创伤性骨折相关的溶骨性病变在影像学上表现不具特异性，我们强调PBL是一个重要的诊断考虑因素。
