title: Non-Hodgkin's lymphoma: unexpected cause of shoulder pain. A systematic review of the literature.
abstract: The non-Hodgkin lymphoma (NHL) is one of the most common shoulder neoplasms, especially the diffuse large B cell lymphoma (DLBCL). We report a rare case of shoulder pain in a 80-year-old man presenting with a six-month history of continuous severe pain to the right shoulder. Routine laboratory studies were normal. Shoulder MRI showed an in-growing inhomogeneous lesion in the anteromedial aspect of the right humeral head extended within the cortical bone of the humerus (osteolitic lesion), next to the surrounding soft tissues. He also underwent shoulder arthroscopy: the intra-articular involvement of the shoulder was therefore excluded. A percutaneous bone biopsy performed on the same day was diagnostic for lymphoma. Three days later, the patient underwent surgical excision of the mass; a reverse shoulder prosthesis was then implanted (Aequalis reversed prosthesis). The patient started chemiotherapy according with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen, but did not tolerate it because of the sudden onset of herpes zoster. At 9-month follow-up, the patient is doing well, with fair range of motion, due to the delay of rehabilitation, but no shoulder pain and no evidence of local or systemic recurrence. A painful shoulder may be due to lymphoma even in the absence of classical symptoms. In suspected patients, plain radiographs should be followed by magnetic resonance imaging and bone biopsy. Tumor removal and shoulder arthroplasty can be an effective therapy. Given the devastating side effects of adjuvant chemotherapy, we do not recommend it in elderly patients.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy.
authors.forename: Manlio Fabio
authors.initials: MF
authors.lastname: Caporale
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy.
authors.forename: Giovanni Francesco
authors.initials: GF
authors.lastname: Gambino
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy.
authors.forename: Fabio Saverio
authors.initials: FS
authors.lastname: Larosa
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital Antonio Cardarelli, Campobasso, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Del Buono
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hospital SS Gonfalone, Monterotondo (RM), Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Segni
keywords: differential diagnosis; non-Hodgkin lymphoma; shoulder pain; surgery