Bone Involvement in Malignant Lymphoma

The purpose of this study is to review the problem of involvement of bone by malignant lymphoma, to attempt to determine what influence, if any, such involvement may have on the course of the disease and well-being of the patient, and to try to solve such other problems related to the disease as the extent and nature of the data available will allow. In the Tumor Clinic of the Massachusetts General Hospital, in the ten-year period from January 1936 through December 1945, a clinical diagnosis of lymphoma of one variety or another was made in 402 patients 2.In 313 of these the diagnosis was proved by histologic examination, either of a specimen secured by biopsy or during a surgical operation, or at autopsy. Discarding 25 cases of mycosis fungoides, there remain 288 histologically proved cases upon which the following review is based. The determination of involvement of bone was by means of roentgenograms and by postmortem examination. In one case only was bone involvement found postmortem which had not been previously recognized roentgenologically. While it is well known that considerable involvement of bone by tumor is necessary before demonstration by roentgenogram is possible, it would seem that in these cases of malignant lymphoma the disease progressed slowly enough so that the majority of the bone lesions were diagnosed antemortem. Exclusive of the leukemias and the disease which is termed paragranuloma by Jackson and Parker (5, 6), the classifications adhered to in this community are that of the latter authors and that of Gall and Mallory (3); the two are quite similar save for nomenclature. For the purpose of this study, and in order that no individual group may be too small, the classification of Jackson and Parker is used. Incidence of Bone Involvement In Table I, Column A shows the grouping of the 288 cases. Hodgkin's granuloma is the most commonly occurring form of malignant lymphoma, almost one-third of the patients falling into that group; Hodgkin's sarcoma and giant-cell follicular lymphoma are the least common, each accounting for less than 10 per cent of the series. Of the entire group of 288 patients, 38 or 13 per cent had manifest involvement of bone at the time of the first observation or sometime later in the course of the disease. As seen in Column B (Table I), the incidence of discrete bone involvement in each group of patients roughly parallels the frequency of the disease in the group as a whole, with the exception of the giant follicular type of lymphoma in which the figure is disproportionately low.