ABSTRACT
Abstract Primary bone lymphoma is a rare neoplasm that can initially present as local pain, a palpable mass, and pathologic fracture. It can also be discovered as an incidental finding on an imaging examination. It is defined as a bone marrow tumor with no involvement of other sites, lasting at least six months. The diagnosis is confirmed by biopsy and immunohistochemical analysis. Although the imaging characteristics are nonspecific, there are certain findings that, when correlated with clinical and epidemiological aspects, can increase the level of suspicion of primary bone lymphoma. The classic imaging aspect is a bone lesion with a soft-tissue component that preserves the cortical layer more than would be expected given the invasive nature of the lesion. Magnetic resonance imaging is the best imaging method to evaluate the extent of involvement of adjacent compartments, whereas computed tomography depicts the cortical layer in greater detail, as well as being an important tool for biopsy guidance. Other imaging modalities are also discussed, such as X-ray, ultrasound, bone scintigraphy, and positron emission tomography/computed tomography. The aim of this paper is to describe the most common findings obtained with the various imaging methods used in patients with a confirmed diagnosis of primary bone lymphoma.
Resumo Linfoma ósseo primário é uma neoplasia rara, apresentando-se com dor, massa palpável e fratura patológica ou, ainda, como achado incidental em exames de imagem. É definido por tumor medular ósseo com ausência de acometimento de outros sítios por pelo menos seis meses, sendo confirmado por biópsia e avaliação imuno-histoquímica. As características de imagem são inespecíficas, mas alguns achados, quando associados a outros aspectos clinicoepidemiológicos, podem ajudar e aumentar o nível de suspeição para esta entidade. Lesão óssea com componentes de partes moles e relativa preservação cortical maior que a esperada configura uma das principais características de linfoma ósseo primário. A ressonância magnética é o melhor método de imagem para avaliar a extensão da lesão óssea para os compartimentos de partes moles, enquanto a tomografia computadorizada avalia com detalhes a cortical óssea, sendo também uma ferramenta importante para orientação de biópsias. Outras modalidades de imagem também são discutidas, como radiografia, ultrassonografia, cintilografia óssea e tomografia por emissão de pósitrons/tomografia computadorizada. O objetivo deste trabalho é descrever os achados mais frequentes nos diferentes métodos de imagem utilizados em pacientes com linfoma ósseo primário com diagnóstico confirmado em um centro oncológico de referência.
ABSTRACT
Background Primary conjunctival lymphoid hyperplasia exhibit atypical clinical symptoms and easy to cause misdiagnosis and mistreatment.Understanding the clinical characteristics of primary conjunctival lymphoid hyperplasia is of an important clinical significance.Objective This study was to analyze the clinical characteristics and therapeutic outcome of patients with primary conjunctival lymphoid hyperplasia.Methods The medical records of 20 patients with primary conjunctival lymphoid hyperplasia who was treated in Beijing Tongren Hospital from January 2012 to December 2014 were retrospectively analyed.The age,symptoms,therapy,prognosis,histopathological features and immonochemistry results were reviewed,and the treating approach targeting to different types of conjunctival lymphoid hyperplasia was evaluated.The fellow-up duration was 1-2 years.Results Age of the patients ranged from 27 to 83 years old.The lesions were classified as benign lymphocytic hyperplasia,atypical lymphoid hyperplasia and lymphoma.Majority of lesions located in fornix conjunctiva tissue (90％).Follicle-like appearance was seen in the benign lymphocytic hyperplasia,and pink elavation was exhibited at the bulbar conjunctiva in the atypical lymphoid hyperplasia.A diffuse salmon fish like appearance in conjunctiva was the primary feature of conjunctival lymphoma.Histopathological examination showed that conjunctival benign lymphocytic hyperplasia had follicle-like tissue in lesions,atypical lymphoid hyperplasia exhibited diffuse lymphocyte filtration,and conjunctival lymphoma appeared monocyte filtration.The 3 tpyes of lesions also could be differentiated by immunochemistry.The medicine was applied in the eyes with benign lymphocytic hyperplasia,and the combination of resection of lesions with conjunctival tissue or amniotic membrane transplantation was used for the atypical lymphoid hyperplasia or lymphoma eyes.No recurrence of the lesions was found during fellow-up duration.Conclusions The clinical manifestations of conjunctival lymphoid hyperplasia lesions are varied,and it is easy to be confused with chronic ocular surface diseases.Pathology and immunochemistry are helpful for the differential diagnosis.The treating regimen is dependent on the lesion type.Most patients have a favorable prognosis with treatment.