title: Composite B-cell and T-cell non-Hodgkin lymphoma of the tibia.
abstract: We report a unique case of de novo composite lymphoma in the tibia of a 35-year-old man who presented with increasingly frequent and intense pain in the right upper leg. He was otherwise healthy without significant medical history. A plain radiograph of the right leg showed a permeative lesion with alternating areas of radiolucency and radiodensity in the upper third of the tibia. Magnetic resonance imaging showed a large, heterogeneous enhancing lesion involving the medullary and cortical bone of the proximal tibia with cortical disruption and extension into the adjacent soft tissue. A biopsy showed sheets and clusters of large cells, punctuated by clusters of small, irregular lymphocytes. Flow cytometry and immunohistochemical analysis showed composite lymphoma: diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell non-Hodgkin lymphoma with predominantly small cell morphologic features. The DLBCL expressed CD19, CD20, CD79a, CD5, CD10, CD23, CD38, CD117, bcl-2, and bcl-6, with monotypic expression of immunoglobulin kappa light chain. The T cells expressed CD2, CD3, CD5, CD7, and CD8, with partial loss of CD4. Clonal rearrangement of T-cell receptor gamma chain gene was found. Neither the large B cells nor the small T cells expressed Epstein-Barr virus-encoded RNA. Physical examination and radiologic studies showed no evidence of lymphadenopathy, organomegaly, or other mass lesions in the body. No peripheral lymphocytosis or bone marrow involvement was present.
authors.affiliation: Department of Pathology, Creighton University Medical Center, Omaha, NE 68131, USA.
authors.forename: Zahid
authors.initials: Z
authors.lastname: Kaleem
authors.forename: Michael H
authors.initials: MH
authors.lastname: McGuire
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Caracioni
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Leonard
authors.forename: M Hanif
authors.initials: MH
authors.lastname: Pathan
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Lessmann
authors.forename: Wing C
authors.initials: WC
authors.lastname: Chan
mesh_terms: D000328:Adult; D015703:Antigens, CD / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis; D001859:Bone Neoplasms / Q000737:chemistry / Q000473:pathology*; D002999:Clone Cells; D005434:Flow Cytometry; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000032:analysis; D007150:Immunohistochemistry; D016393:Lymphoma, B-Cell / Q000737:chemistry / Q000473:pathology*; D016411:Lymphoma, T-Cell, Peripheral / Q000737:chemistry / Q000235:genetics / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000737:chemistry / Q000473:pathology*; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D015703:Antigens, CD; D014408:Biomarkers, Tumor; D007145:Immunoglobulin kappa-Chains