Lymphoma of Bone = RETICULUM CELL SARCOMA = HISTIOCYTIC LYMPHOMA = PRIMARY LYMPHOMA OF BONE • = singular bone lesion • the generalized

form of reticulum cell sarcoma is lymphoma Prevalence 5% of all primary bone tumors; <1% of all NHL; 2–6% of all : primary malignant bone tumors in children • Incidence of bone marrow involvement: o 5–15% in Hodgkin disease; o 25–40% in non-Hodgkin lymphoma o Bone marrow involvement indicates progression of disease o Bone marrow imaging-guidance for biopsy! NUC: 40% sensitivity; 88% specificity MR: 65% sensitivity; 90% specificity Histo mostly large B-cell category; sheets of reticulum cells, larger than those : in Ewing sarcoma (DDx: myeloma, inflammation, osteosarcoma, eosinophilic granuloma) Age: bimodal distribution with peaks in 2nd–3rd and 5th–6th decades; 50% <40 years; 35% <30 years; M:F = 2:1 • • chronic dull pain • • striking contrast between size of lesion + patient's well-being Location lower femur, upper tibia (40% about knee), humerus, pelvis, scapula, : ribs, vertebra Site: dia- / metaphysis • cancellous bone erosion (earliest sign) • mottled permeative pattern of separate coalescent areas • late cortical destruction • lamellated / sunburst periosteal response (rare and less than in Ewing sarcoma) • lytic / reactive new-bone formation • associated soft-tissue mass without calcification (70%) • synovitis of knee joint common

Cx: pathologic fracture (most common among malignant bone tumors) Prognosis 54% 5-year survival : DDx: (1) Osteosarcoma (less medullary extension, younger patients) (2) Ewing tumor (systemic symptoms, debility, younger patients) (3) Metastatic malignancy (multiple bones involved, more destructive)