Ozdemirli M, Mankin H J, Aisenberg A C, Harris N L
James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Cancer. 1996 Jan 1;77(1):79-88. doi: 10.1002/(SICI)1097-0142(19960101)77:1<79::AID-CNCR14>3.0.CO;2-5.
Hodgkin's disease (HD) rarely presents as a solitary bone tumor. Fewer than 20 such cases have been reported in the English literature; many of these were reported prior to the development of immunohistologic markers for HD and T- and B-cell lymphomas. In this report, we describe four cases of HD that presented as a localized solitary mass in bone; the diagnosis was confirmed by immunohistochemical studies in all cases.
The biopsy specimens of four cases identified in our files were studied by conventional histopathology and immunohistochemistry. Clinical data and follow-up information were obtained for all patients.
Three cases presented as a localized, solitary mass in the ilium and one case in the vertebra (T12). Three patients were female and one male. The average age was 43 years. Three of the patients presented with lower back pain without constitutional symptoms. All had solitary osteoblastic lesions. All four cases were diagnostic problems, and the diagnosis was confirmed in each case only after finding lymph node involvement. Bone biopsies showed fibrosis and a mixed inflammatory infiltrate with rare atypical cells. All four patients were subsequently found to have nodal involvement by HD. The histology of the associated nodal disease was mixed cellularity in two cases and nodular sclerosis in two. On immunohistochemical staining, the neoplastic cells in all cases expressed CD15 and CD30 and lacked CD45 and other B- and T-cell antigens. Three patients who were treated for HD are alive and well, 1, 6, and 14 years later.
Although rare, HD should be considered in the differential diagnosis of solitary bone lesions. Most patients who present with apparently solitary HD of bone prove to have nodal involvement. Long-term survival is possible with aggressive treatment.
霍奇金淋巴瘤（HD）极少表现为孤立性骨肿瘤。英文文献中报道的此类病例不足20例；其中许多病例是在HD以及T细胞和B细胞淋巴瘤的免疫组织化学标志物出现之前报道的。在本报告中，我们描述了4例HD表现为骨局限性孤立性肿块的病例；所有病例均通过免疫组织化学研究确诊。
对我们档案中确定的4例病例的活检标本进行常规组织病理学和免疫组织化学研究。获取了所有患者的临床资料和随访信息。
3例表现为髂骨局限性孤立性肿块，1例表现为胸椎（T12）肿块。3例患者为女性，1例为男性。平均年龄为43岁。3例患者表现为下背部疼痛，无全身症状。所有患者均有孤立性成骨病变。所有4例在诊断上均存在问题，且仅在发现淋巴结受累后才确诊。骨活检显示纤维化和混合性炎症浸润，可见罕见的非典型细胞。所有4例患者随后均被发现有HD累及淋巴结。相关淋巴结疾病的组织学表现为2例为混合细胞型，2例为结节硬化型。免疫组织化学染色显示，所有病例中的肿瘤细胞均表达CD15和CD30，且缺乏CD45及其他B细胞和T细胞抗原。3例接受HD治疗的患者在1年、6年和14年后仍存活且状况良好。
尽管罕见，但在孤立性骨病变的鉴别诊断中应考虑HD。大多数表现为明显孤立性骨HD的患者最终被证明有淋巴结受累。积极治疗有可能实现长期生存。
