Primer kemik lenfomalarının değerlendirilmesi ve pozitron emisyon tomografisinin önemi

Yıl 2014, Cilt: 48 Sayı: 3, 371 - 378, 30.05.2014

Alper Cirakli Murat Elli Nevzat Dabak Fevziye Canbaz Tosun Ayhan Dagdemir Sevgi Cirakli

https://doi.org/10.3944/AOTT.2014.3014

Öz

Kemiğin primer lenfoması, non-Hodgkin lenfoma veya Hodgkin lenfoma şeklinde, oldukça nadir görülen bir tümördür. Büyük kısmını non-Hodgkin lenfomanın oluşturduğu lenfomaların alt tipleri içerisinde en sık diffüz büyük hücreli lenfomaya rastlanır. Hastalar ağrı, şişlik veya patolojik kırık ile başvurabilirler. Kesin tanı biyopsi ile konulur. Tedavi kemoterapi, radyoterapi ve cerrahiden oluşan yaklaşım ile düzenlenir. Çalışmamızda ağrı ve şişlik nedeniyle başvuran 3 erkek olgu bildiriyoruz. Femur distali, fibula proksimali ve iliak kanat tutulum bölgelerini oluşturmakta idi. Histopatolojik olarak non-Hodgkin lenfoma tanısı aldıktan sonra tüm olgulara kemoterapi tedavisi uygulandı. Femur distal tutulumu olan olguya distal femur rezeksiyon protezi uygulandı. Fibula başı tutulumu olan olguda düşük ayak ve yara iyileşmesinde gecikme gözlendi. Flor-18-florodeoksiglikoz pozitron emisyon tomografisi/bilgisayarlı tomografi uygulanan tüm hastalar tedaviye tam yanıt verdi. Güncel takipteki olgular remisyonda ve okullarına devam etmektedirler.

Anahtar Kelimeler

Kemik; lenfoma; pozitron emisyon tomografisi

Evaluation of primary bone lymphoma and the importance of positron emission tomography

Öz

Primary lymphoma of the bone is an extremely rare tumor in the form of non-Hodgkin lymphoma or Hodgkin lymphoma. The majority of primary bone lymphomas are non-Hodgkin lymphoma, of which the most common subtype is diffuse large cell lymphoma. Patients can present with pain, swelling or pathologic fracture. Definitive diagnosis is made after biopsy examination. Treatment consists of chemotherapy, radiotherapy and surgery. We report 3 male patients who presented with pain and swelling. Involvement was in the distal femur, proximal fibula and iliac crest in all patients. Patients were diagnosed with non-Hodgkin lymphoma in biopsy examination and underwent chemotherapy. The patient with distal femoral involvement underwent distal femoral resection prosthesis. Another patient with involvement of the fibular head experienced foot drop and delayed wound healing. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography revealed complete response to the treatment. Patients are in remission and continue schooling.

Anahtar Kelimeler

Bone, lymphoma, positron emission tomography

Kaynakça

• Osborn LM, Dewitt TG, First LR, Zenel JA. Pediatrics. In: Yurdakök M, translator/editor. Ankara: Güneş Kita- bevi; 2007. p. 1089-197.
• Power DG, McVey GP, Korpanty G, Treacy A, Dervan P, O’Keane C, et al. Primary bone lymphoma: single institu- tion case series. Ir J Med Sci 2008;177:247-51. CrossRef
• Ramadan KM, Shenkier T, Sehn LH, Gascoyne RD, Connors JM. A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population- based study of successively treated cohorts from the Brit- ish Columbia Cancer Agency. Ann Oncol 2007;18:129- 35. CrossRef
• Bhagavathi S, Fu K. Primary bone lymphoma. Arch Pathol Lab Med 2009;133:1868-71.
• Seidemann K, Tiemann M, Schrappe M, Yakisan E, Simo- nitsch I, Janka-Schaub G, et al. Short-pulse B-non-Hodg- kin lymphoma-type chemotherapy is efficacious treatment for pediatric anaplastic large cell lymphoma: a report of the Berlin-Frankfurt-Münster Group Trial NHL-BFM 90. Blood 2001 ;97:3699-706. CrossRef
• Parker JW, Jackson H. Primary reticulum cell sarcoma of bone. Surg Gynecol Obstet 1939;68:45-53.
• Canale ST. Campbell’ s operative orthopaedics. In: Heck RK, editor. Akgün I, translator/editor. İstanbul: Hayat Tıp Kitapçılık; 2007. p. 846-7.
• Boston HC Jr, Dahlin DC, Ivins JC, Cupps RE. Malig- nant lymphoma (so-called reticulum cell sarcoma) of bone. Cancer 1974;34:1131-7. CrossRef
• Pettit CK, Zukerberg LR, Gray MH, Ferry JA, Rosenberg AE, Harmon DC, et al. Primary lymphoma of bone. A B- cell neoplasm with a high frequency of multilobated cells. Am J Surg Pathol 1990;14:329-34. CrossRef
• Skinner HB. Lange’s current orthopedics diagnosis and treatment. In: Alpaslan M, translator/editor. Ankara: Güneş Tıp Kitabevi; 2005. p. 325-6.
• Suryanarayan K, Shuster JJ, Donaldson SS, Hutchison RE, Murphy SB, Link MP. Treatment of localized primary non-Hodgkin’s lymphoma of bone in children: a Pediatric Oncology Group study. J Clin Oncol 1999;17(2):456-9.
• Bhagavathi S, Micale MA, Les K, Wilson JD, Wiggins ML, Fu K. Primary bone diffuse large B-cell lymphoma: clinicopathologic study of 21 cases and review of litera- ture. Am J Surg Pathol 2009;33:1463-9. CrossRef
• Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer 2010;116:871-9. CrossRef
• Şanverdi SE, Parlak S, Görür MB, Aksoy YE. Tibial pri- mary malignant lymphoma: direct radiography and MRI findings. [Article in Turkish] Ankara Üniversitesi Tıp Fakültesi Mecmuası 2004;57:273-8.
• Jhanwar YS, Straus DJ. The role of PET in lymphoma. J Nucl Med 2006;47:1326-34.
• Kirby AM, Mikhaeel NG. The role of FDG PET in the management of lymphoma: what is the evidence base? Nucl Med Commun 2007;28:335-54. CrossRef
• Mut SŞ, Halaç M, Sönmezoğlu K, Ergul N, Uslu İ. Im- portance of FDG PET/BT imaging protocol in lympho- mas. [Article in Turkish] Turk J Nucl Med 2007;16:69- 72.
• Moog F, Bangerter M, Diederichs CG, Guhlmann A, Merkle E, Frickhofen N, et al. Extranodal malignant lym- phoma: detection with FDG PET versus CT. Radiology 1998;206:475-81.
• Sasaki M, Kuwabara Y, Koga H, Nakagawa M, Chen T, Kaneko K, et al. Clinical impact of whole body FDG- PET on the staging and therapeutic decision making for malignant lymphoma. Ann Nucl Med 2002;16:337-45.
• Partridge S, Timothy A, O’Doherty MJ, Hain SF, Rankin S, Mikhaeel G. 2-Fluorine-18-fluoro-2-deoxy-D glucose positron emission tomography in the pretreatment staging of Hodgkin’s disease: influence on patient management in a single institution. Ann Oncol 2000;11:1273-9. CrossRef
• Naumann R, Beuthien-Baumann B, Reiss A, Schulze J, Hänel A, Bredow J, et al. Substantial impact of FDG PET imaging on the therapy decision in patients with early- stage Hodgkin’s lymphoma. Br J Cancer 2004;90:620-5.
• Wirth A, Seymour JF, Hicks RJ, Ware R, Fisher R, Prince M, et al. Fluorine-18 fluorodeoxyglucose positron emis- sion tomography, gallium-67 scintigraphy, and conven- tional staging for Hodgkin’s disease and non-Hodgkin’s lymphoma. Am J Med 2002;112:262-8. CrossRef
• Türk HM, Kalender ME. Positron emission tomogra- phy imaging in lymphomas. [Article in Turkish] UHOD 2006;16:108-13.
• Kostakoglu L, Coleman M, Leonard JP, Kuji I, Zoe H, Goldsmith SJ. PET predicts prognosis after 1 cycle of che- motherapy in aggressive lymphoma and Hodgkin’s disease. J Nucl Med 2002;43:1018-27.
• Reddy N, Greer JP. Primary bone lymphoma: a set of unique problems in management. Leuk Lymphoma 2010;51:1-2. CrossRef
• Reinhardt MJ, Herkel C, Altehoefer C, Finke J, Moser E. Computed tomography and 18F-FDG positron emission tomography for therapy control of Hodgkin’s and non- Hodgkin’s lymphoma patients: when do we really need FDG-PET? Ann Oncol 2005;16:1524-9. CrossRef