HODGKINS-DISEASE PRESENTING AS A SOLITARY BONE-TUMOR - A REPORT OF 4 CASES AND REVIEW OF THE LITERATURE

BACKGROUND. Hodgkin's disease (HD) rarely presents as a solitary bone tumor. Fewer than 20 such cases have been reported in the English lite rature; many of these were reported prior to the development of immuno histologic markers for HD and T- and B-cell lymphomas. In this report, we describe four cases of HD that presented as a localized solitary m ass in bone; the diagnosis was confirmed by immunohistochemical studie s in all cases. METHODS. The biopsy specimens of four cases identified in our files were studied by conventional histopathology and immunohi stochemistry. Clinical data and follow-up information were obtained fo r all patients. RESULTS. Three cases presented as a localized, solitar y mass in the ilium and one case in the vertebra (T12). Three patients were female and one male. The average age was 43 years. Three of the patients presented with lower back pain without constitutional symptom s. AU had solitary osteoblastic lesions. AU four cases were diagnostic problems, and the diagnosis was confirmed in each case only after fin ding lymph node involvement. Bone biopsies showed fibrosis and a mixed inflammatory infiltrate with rare atypical cells. All four patients w ere subsequently found to have nodal involvement by HD. The histology of the associated nodal disease was mixed cellularity in two cases and nodular sclerosis in two. On immunohistochemical staining, the neopla stic cells in all cases expressed CD15 and CD30 and lacked CD45 and ot her B- and T-cell antigens. Three patients who were treated for HD are alive and well, 1, 6, and 14 years later.CONCLUSIONS. Although rare, HD should be considered in the differential diagnosis of solitary bone lesions. Most patients who present with apparently solitary HD of bon e prove to have nodal involvement. Long-term survival is possible with aggressive treatment. (C) 1996 American Cancer Society.