Primary (Malignant) Lymphoma of Bone Clinical Presentation

Updated: Oct 29, 2018
  • Author: Vincent Y Ng, MD; Chief Editor: Harris Gellman, MD  more...
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Presentation

History

The most common presentation of primary lymphoma of bone (PLB; also referred to as reticulum cell sarcoma, malignant lymphoma of bone, or osteolymphoma) consists of several months of bone pain and the appearance of a soft-tissue mass. Constitutional symptoms (B symptoms), such as weight loss, fever, and night sweats, are present in fewer than 10% of patients with PLB. Hypercalcemia is seen in some pediatric patients and has been associated with a poorer prognosis. PLB may be rarely seen in patients with AIDS, immunosuppression, and Paget disease of bone.

The severity of bone pain should be ascertained, particularly with weightbearing. Activity-related pain that subsides with rest or worsening pain despite adjuvant chemoradiation may be indicative of structural insufficiency and the need for prophylactic fixation.

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Physical Examination

Patients with PLB may present with a prominent mass, even with minimal radiographic changes. All lymph nodes should be palpated. Nodal involvement is rare with primary soft-tissue or bone sarcomas, but is an important factor in managing lymphoma. (See the image below.)

Clinical photo of a left shoulder shows a prominen Clinical photo of a left shoulder shows a prominence in the midportion of the left clavicle. This 45-year-old man was suffering from local pain and tenderness but had no history of prior trauma.
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