Revision 3 for 'Primary bone lymphoma'

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Primary bone lymphoma

Primary bone (skeletal/osseous) lymphoma (PBL) is a less common manifestation than secondary involvement from disseminated lymphoma. It is a rare, accounting for <5% of bone tumors and <1% of non-Hodgkin lymphoma

Terminology

PBL is defined as the presence of lymphoma isolated to one bone without distant spread for six months after diagnosis. Multifocal PBL is less common and occurs with lymphoma is confined to two or more bones, again without distant spread for six months 1

Epidemiology

PBL can affect any age group, with peak incidence in 50-to-60 year olds. It is rare in children <10 years old. There is a slightly male predominance (M:F = 1.5:1) 2

Clinical presentation

Symptoms include localized pain and swelling; B-type symptoms; pathological fractures; and cord compression

Pathology

Lymphoma of the non-Hodgkin type is the most common subtype. 

Radiographic features

Plain film

PBL has non-specific features and may be normal, lytic, sclerotic or mixed. The common pattern is a lytic pattern with permeative bone destruction with a wide zone of transition 1

MRI

Associated soft tissue masses are common. Bone marrow changes include 2:

  • T1: low signal
  • T2: high signal

Differential diagnosis

For plain film presentation of permeative bone destruction consider 1:

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