Cancer Res Treat.  2007 Dec;39(4):181-184.

Unusual Presentation of Large B Cell Lymphoma- Bone and Stomach- Treated with Autologous Transplantation

• Kim B
• Oh SY
• Lee S
• Kwon HC
• Kim SH
• Hong SH
• Kim SS
• Kim HJ

Abstract

Extranodal presentation of diffuse large B cell lymphoma (DLBL) is frequently observed in the gastrointestinal tract, CNS, bone, testes and liver. However, the simultaneous detection of multiple extranodal involvement at presentation is quite an uncommon occurrence. In this study, we report on a patient with an uncommon presentation of DLBL, and he had symptoms of left knee joint pain and hematemesis, characterized by bone and stomach involvement. Computed tomography and fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning revealed a rapid, extensive spread to the bones and soft tissues. Subsequent histopathological examination verified the bony and gastric CD20-positive DLBL localization. We diagnosed this case as DLBL of stage IV with an international prognostic index of 3, and classified him into the high intermediate risk group. This patient was treated via chemotherapy with an R-CHOP regimen. After achieving a partial response, the patient received autologous peripheral blood stem cell transplantation. The patient attained partial remission, as shown on the FDG-PET scan, and he displayed improvement of his left femur pain.

Keyword

Extranodal; Diffuse large B-cell lymphoma; Stomach; Bone

MeSH Terms

Autografts*
Drug Therapy
Femur
Gastrointestinal Tract
Hematemesis
Humans
Knee Joint
Liver
Lymphoma, B-Cell
Peripheral Blood Stem Cell Transplantation
Stomach
Testis
Transplantation, Autologous*

Figure

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  Fig. 1 Left knee magnetic resonance imaging series. (A) Left knee magnetic resonance imaging (MRI) initially shows lymphoma involvement of the distal femur, proximal tibia, fibula etc. and extension to the suprapatellar fat pad. (B) Left knee MRI after 3 cycles of chemotherapy. (C) Left knee MRI after 6 cycles of chemotherapy.

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  Fig. 2 Endoscopic findings of the patient. Note the gastric ulcer in the lower body and posterior wall of the angle of the stomach.

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  Fig. 3 Pathologic findings of the bone and stomach. (A) Haematoxylin-eosin staining showing the bone tissue with diffuse infiltration by large lymphomatous cells (×400). (B) Lymphomatous cells expressing CD 20 antigen (×400) in the bone tissue. (C) Infiltration of the gastric mucosal and submucocal layer by dense neoplastic lymphoid cells (H&E, ×200).

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  Fig. 4 The FDG-PET scanning of the patient. (A, B) The FDG-PET scanning revealed multiple bony involvements of both the femur and fibula (max SUV: 19.0) with soft tissue extension (max SUV: 20.7). Multiple hypermetabolic lesions were observed in the right upper internal jugular (max SUV: 2.7), right supraclavicular (max SUV: 3.0), and right interpectoral (max SUV: 2.6) lymph nodes. (C) The follow-up FDG-PET scanning after 6 cycles of chemotherapy shows a markedly improved condition, but hypermetabolic lesions persisted in the left femur and both tibias (max SUV: 1.8). (D) The follow-up FDG-PET scanning after PBSCT shows a slight improvement in the condition of the left femur (max SUV: 1.1).

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