Summary
A case of a 19-year-old female patient with a primary B-cell lymphoma of bone is presented. Although extensive diagnostic procedures including CT and MRI scans as well as bone histology were used, the case was initially misdiagnosed as chronic osteomyelitis. Resection of the distal femur including the knee joint was performed and bisegmental callus distraction was initiated. After local exacerbation a B-cell lymphoma was diagnosed histologically and immunohistochemically in a soft tissue specimen. Above-knee amputation had to be carried out due to severe local soft tissue necrosis and superinfection. Diagnostic problems arose from non-specific clinical symptoms, uncertain radiographic signs and non-diagnostic histology. Growth factors may have stimulated tumor growth after initiation of callus distraction.
Résumé
Le cas d'une jeune femme de 19 ans porteuse d'un lymphome à cellules béta primitif est présenté. Une imagerie médicale complète avec scanner, IRM ainsi qu'une étude histologique ont été nécessaires au diagnostic, qui a d'abord été erroné avec suspicion d'ostéomyélite chronique. Une résection du fémur distal comprenant le genou a été réalisée et une distraction bipôlaire du cal fut ensuite appliquée. Après une inflammation locale, le diagnostic de lymphome à cellules béta put être posé et une étude immunohistochimique sur un prélèvement de tissus mous fut demand'ee. Une amputation de cuisse dut être effectuée à cause d'une grave nécrose et d'une surinfection des tissus mous. Des problèmes diagnostiques survinrent à cause de symptomes aspécifiques, d'incertitudes radiologiques et d'une absence de diagnostic histologique. Les facteurs de croissance ont probablement stimulé la croissance tumorale après la mise en route de la distraction du cal.
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Eingartner, C., Adler, C.P., Fritzl, J. et al. Primary B-cell lymphoma in the distal femur: Diagnostic and therapeutic problems. Eur J Orthop Surg Traumatol 7, 281–284 (1997). https://doi.org/10.1007/BF00595133
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DOI: https://doi.org/10.1007/BF00595133