title: Primary multifocal osseous Hodgkin disease: a case report and review of the literature.
abstract: OBJECTIVE
  Hodgkin disease (HD) typically involves the lymphatic system at one or more sites. Rarely, Hodgkin disease presents as an osseous lesion without involvement of lymph nodes. Therefore, the histologic diagnosis of osseous HD can be problematic. We present a rare case of multifocal osseous HD and a review the literature with special emphasis on treatment and prognosis.
  
  
  METHODS
  Osteomyelitis and lymphoma are the main differential diagnoses and can only be excluded histologically by the presence of Sternberg Reed cells or by immunohistochemical examinations. This case reports a 21-year old man with a Hodgkin lymphoma located at the proximal femur and the proximal tibia.
  
  
  RESULTS
  Staging studies revealed no other tumor manifestations. Regarding the Ann Arbor classification, the presented case should be a stage IV disease. The patient is without evidence of disease 4 years after curettage, local radiation therapy, and systemic chemotherapy despite the poor prognosis considering the Ann Arbor classification.
  
  
  CONCLUSIONS
  Reviewing the few reported cases, osseous HD must be distinguished from systemic HD with diffuse bone marrow involvement and from osseous metastases in advanced stage of disease because it seems to have a better prognosis.
authors.affiliation: Department of Orthopedics, University of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany. cgebert@uni-muenster.de
authors.forename: C
authors.initials: C
authors.lastname: Gebert
authors.forename: J
authors.initials: J
authors.lastname: Hardes
authors.forename: H
authors.initials: H
authors.lastname: Ahrens
authors.forename: H
authors.initials: H
authors.lastname: Buerger
authors.forename: W
authors.initials: W
authors.lastname: Winkelmann
authors.forename: G
authors.initials: G
authors.lastname: Gosheger
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology