Lymphoma




CLINICAL SUMMARY


The lymphoid malignancies are a large and heterogeneous group. Bone involvement is usually a manifestation of late, disseminated disease, although bone infrequently can be the primary site. In almost all instances, lymphoma is treated with a combination of radiation and chemotherapy. The prognosis depends on disease stage and lymphoma subtype.




DIAGNOSTIC FEATURES





















History


  • Peak incidence in the sixth and seventh decades



  • Pain and swelling are common



  • Symptoms can be indolent

Location


  • Diaphyseal is most common



  • May be multifocal; often involves the femur

Margins


  • Subtle, motheaten to permeative destruction



  • Large soft tissue mass

Matrix


  • Areas of lysis mixed with reactive bone formation



  • Sclerosis can be a prominent feature






IMAGING
























  • Lymphoma can appear normal on radiographs in the absence of focal cortical destruction, as seen in this example ( left ). However, the adjacent bone scan reveals involvement of the majority of the femur.



  • A permeative pattern of destruction, encompassing the diaphyseal and metaphyseal regions, is seen in a different patient ( right ).


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