Primary Lymphoma of the Humerus

Howard T Heller, MD
Nayer Nikpoor, MD

May 3, 1996

Presentation

A 25-year-old man presented with right arm pain after heavy lifting on the job.

Imaging Findings

Plain radiograph of the humerus

Anteromedial CT of the humerus

STIR MRI of humerus

T1-weighted MRI of humerus

Bone scintigraphy

The plain radiograph shows a non-displaced fracture through a permeative lytic lesion (arrow) of the middle-to-proximal third of the right humerus.

Computed tomography (CT) reveals a region of cortical destruction (arrow).

On an inversion recovery magnetic resonance (STIR MR) image, an abnormal signal extends from the surgical neck to the mid diaphysis. Minimal soft tissue signal abnormality (arrow) is visible in the flexor compartment. A small soft tissue component (arrow) is also visible on the T1-weighted images.

The lesion shows markedly increased radiotracer uptake on bone scan (arrows). A second area of increased uptake in the right fifth rib is likely to be post-traumatic, based on the pattern of uptake.

Differential Diagnosis

Small cell tumor, such as lymphoma or Ewing's sarcoma
Metastases, such as melanoma or renal cell
Eosinophilic granuloma

Diagnosis

Large cell lymphoma

Discussion

Osseous involvement by lymphoma is generally seen as part of a multisystem dissemination. Primary lymphoma of bone accounts for only 5% of primary malignant bone tumors, is most often seen in patients over 20 years of age, and is more common in men than women. Histologic or radiologic evaluation of a solitary lesion cannot differentiate the two processes. However, gallium scintigraphy is often helpful in evaluating metastasis (differentiating primary from systemic illness). In this patient, a gallium scan after diagnosis revealed the site in the humerus to be the only one with avid uptake.

Symptoms of primary bone lymphoma are local, namely pain and swelling. The metaphyseal region of tubular bones is most commonly involved. Osseous disease is more likely to represent non-Hodgkin's than Hodgkin's lymphoma. When Hodgkin's disease involves bone, it is often one manifestation of stage IV widely disseminated disease. When bone is the only site of involvement by lymphoma, prognosis with treatment is much better than for systemic disease.

References

1. Edeiken J, Dalinka M, Karasick D. Edeiken's roentgen diagnosis of diseases of bone. 4th ed. Baltimore: Williams and Wilkins 1990; 1:429-36.

2. Resnick D, Niwayama G. Diagnosis of bone and joint disorders. 2nd ed. Philadelphia: WB Saunders 1988; 4:2469-81.

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