Synonyms

• Primary Bone NHL
• Bone lymphoma

Category

Bone

Behaviour

Malignant

Grade

High

Gender

Both equally

Tissue of Origin

Other

Epidemiology

• Rare primary Bone malignancy
• <1% of NHL cases
• Peak incidence in older adults
• Predilection for femur and pelvis

Clinical Features

• Bone pain
• Pathological fracture
• Constitutional symptoms (B symptoms) less common than systemic NHL

Location

• Femur most common
• Pelvis
• Tibia
• Humerus

Imaging

• Plain radiograph: lytic or mixed lesion
• MRI: homogeneous lesion with extensive soft tissue
• PET-CT: FDG avid; assess for other lesions

Pathology

• Clonal B-cell lymphoma (usually DLBCL)
• CD20+, CD79a+, Ki67 High

Genetics

Recurrent translocations depend on subtype

Treatment

• Chemotherapy (R-CHOP or similar)
• Radiotherapy to primary site
• Assess for systemic involvement

Prognosis

• Variable by histology and stage
• 60% 5-year survival with modern R-CHOP

Key Points

• Rare primary Bone malignancy
• Usually DLBCL histology
• Assess for systemic involvement before treatment

Workup - Blood Tests

• FBC, U&E, LFTs, LDH - baseline
• Coagulation screen

Workup - Local Imaging

• Plain radiograph
• MRI Bone - assess primary lesion and marrow involvement

Workup - Biopsy

Core needle or open biopsy - must send fresh for flow cytometry and gene rearrangement studies

Workup - Staging

• CT chest/abdomen/pelvis - systemic staging
• PET-CT - disease burden

Workup - Other

• Haematology/oncology MDT
• Assess for CNS involvement (LP if indicated)

Follow-up Summary

• Post-operative check at 6 weeks + xray of involved bone
• Year 1: 6 monthly xrays