musculoskeletal and connective tissue disorders
Primary Malignant Bone Tumors
Lymphoma of bone
Lymphoma of bone (previously known as reticulum cell sarcoma) affects adults, usually in their 40s and 50s. This usually is a diffuse large B-cell lymphoma. It may arise in any bone. The tumor consists of small round cells, often with a mixture of reticulum cells, lymphoblasts, and lymphocytes. It can develop as an isolated primary bone tumor, in association with similar tumors in other tissues, or as a metastasis from known soft tissue lymphomatous disease. Pain and swelling are the usual symptoms of lymphoma of bone. Pathologic fracture is common. Imaging studies reveal bone destruction, which may be in a mottled or patchy or even infiltrating, permeative pattern, often with a clinical and radiographic large soft tissue mass. In advanced disease, the entire outline of the affected bone may be lost. Biopsy is also done. In isolated primary bone lymphoma, the 5-year survival rate is≥50%. Bone lymphomas are typically treated with systemic chemotherapy. Radiation therapy can be used as an adjuvant in some cases. Stabilization of long bones is often necessary to prevent pathologic fracture. Amputation is indicated only rarely, when function is lost because of pathologic fracture or extensive soft tissue involvement that cannot be managed otherwise. 