Researches And Differential Diagnosis Of Primary Lymphoma Of Bone On Imaging Features

Part ⅠImaging research of primary lymphoma of boneObjective: The incidence of PLB is low,with no characteristic clinical symptoms,so it is very difficult to make right diagnosis before treatment.In this part of the study,we retrospectively analyzed the clinical and imaging features of PLB,and tried to find valuable characteristics for clinical diagnosis.Methods: Confirmed by histopathological examination in the Third Hospital of Hebei Medical University,25 cases of PLB were selected from January 2004 to January 2015,of which 20 cases were men,5 women with the male and female tatio as 4:1.15 cases of PLB were underwent routine X-ray examination,18 cases CT examination,18 cases MRI.16 cases of them were single lesions,among which 13 cases underwent X-ray or CT examination or both,10 MRI.Analyze the clinical manifestation and imaging features of PLB.Results: The age range is between 5 and 72 and the median age is 51,the peak age between 41 to 70(68%).Including single lesion in 16 cases and 9cases of multiple lesions.9 cases of single lesion were located in long bone,3ilium,1 calcaneus,1 lumbar,2 clavicle,66.7%(6/9 cases)in the extremities of long bone.This group of the object were non-Hodgkin’s lymphoma,88%(22/25 cases)are type B cells,and 12%(3/25 cases)are type T cells.The bone destruction in the single lesions of PLB is divided into 3 kinds on X-ray plain film and CT: 1)osteolytic bone destruction: the most one(76.9%),and maximum diameter range of lesions is 2.1 ~ 14.8 cm,bone cortex are varying degrees of destruction,only 10%(1/10 cases)bone cortex has no obvious destruction.2)mixed bone destruction: 15.4%(2/13 cases),including 1 case of subchondral bone destruction.The maximum diameterrange of lesions is 6.1~6.9cm.3)close to the "normal" performance: 7.7%(1/13 cases).On MRI,the lesions are low signal on T1 WI,equisignal(1 case),or slightly high signal(1 case),or mixed signal(1 case)on T2 WI,high signal(7 cases)or mixed signal(2 cases)on T2 WI fat suppression sequence;90%(9/10 cases)shows different degrees of bony cortex damage,such as infiltrating destruction of bone cortex(1/9 cases),cortical discontinuous or interrupt(8/9 cases);80%(8/10)cases show mass formation around disease of bone.The ages of multiple lesions of PLB are above 40 years old,disease regions are located in the pelvis and spine.The lesions present osteolytic destruction,low signal on T1 WI,low signal(1 case),equisignal(1 case)and high signal(1 case)on T2 WI,high signal on T2 WI fat suppression sequence.The maximum diameter range of lesions is 2.7~15.3cm.6 cases have soft tissue mass formation,whose diameter range is 0.7 ~ 14.9 cm.12.5%(2/16 cases)single lesions of PLB and 22.2%(2/9 cases)multiple lesions of PLB are no abnormal performance on X-ray plain film,but CT and MRI show abnormal lesions;In addition,there are 11.1%(1/9 cases)are no abnormal performance on X-ray and CT examination,but MRI shows abnormal lesions.3 cases of them are type T cell lymphoma,including 2 cases of multiple lesions(1 case involving the spines,1 case involving scapula and humerus),1case of single lesion(located in ilium).The lesions present bone destruction,2cases are cortical bone defect,1 case is no cortical destrution.The lesions are low signal on T1 WI,high signal on T2 WI fat suppression sequence.They are accompanied by masses formation,the mass diameter range is 2.3 ~ 14.9 cm.Conclusions:1 The PLB peak onset age is 41 to 70 years old(68%),mainly male.2 The single lesions of PLB are more located in long bone,especially extremities of long bone;mainly present osteolytic bone destruction(76.9%),more cortex damage are seen osteolytic bone destrucion(69.2%).3 The multiple lesions are more located in the pelvis and spine;imaging features between multiple lesions and single lesions have no obvious difference.4 A few cases of PLB show the bone are normal performance on X-ray plain film,but abnormal lesions are showed on the CT or MRI.6 There are no difference in imaging features between types B cells and T cells lymphoma.PartⅡ The differential diagnosis between PLB with other easyto confuse of malignant tumorObjective: Clinically,PLB with SPB,MFH,no periosteum reaction of Ewing’s sarcoma,no tumor bone and periosteum reaction of osteosarcoma performance are similar,which is not easy to distinguish.Therefore,in this part of study,we tries to quantify the indexes after identification of PLB with four kinds of malignant bone tumors.Methods: From January 2004 to January 2015,PLB,SPB,MFH,Ewing’s sarcoma and osteosarcoma confirmed by histopathological examination in the Third Hospital of Hebei Medical University were collected.25 cases of PLB patients,were in the first part of study.32 cases of SPB underwent X-ray or CT examination or both,21 cases underwent MRI.20 cases of MFH underwent X-ray or CT examination or both,21 underwent MRI.13 cases of Ewing sarcoma underwent X-ray or CT examination or both,11 cases underwent MRI.92 cases of osteosarcoma underwent X-ray or CT examination or both,106 cases underwent MRI.PLB compared with above four tumors by indicators are: Lesion regions and ages,the types of lesions destruction and bone cortex destruction,periosteal reaction and calcification or tumor bone,signal characteristic of lesions,soft tissue mass.Using SPSS21.0 statistical software for statistical analysis,the rates were compared by chi-square test.Significant level was a = 0.05,P < 0.05 was defined as have statistical significance.Results:1 Onset age comparisonThe median age is 51 and the peak age is 41 ~ 70 years old(68%)of PLB;the median age is 59 years old and the peak age is 51 ~ 70 years old(78.4%)of SPB;the median age is 44 and the peak age is 31~60 years old(73.9%)of MFH;the median age is 17 and the peak age is 11~20 years old(53.8%)of Ewing’s sarcoma;the median age is 19 and the peak age is 11~20years old(61.2%)of osteosarcoma;the median age is 19 years old and the peak age is 11 ~ 20 years old(56%)of no tumor bone and periosteum reaction osteosarcoma.2 Lesions position comparisonThe SPB group have 54.1%(20/37 cases)located in the axial skeleton,29.7%(11/37 cases)located in long bone of limb,PLB have 56.3%(9/16cases)located in long bone,6.3%(1/16 cases)located in the axial skeleton,so they have statistical significance(P = 0.004).MFH are located in long bone of limbs,52.2%(12/23 cases)located in the diaphysis,26.1%(6/23 cases)located in the extremities,but PLB have 66.7%(6/9 cases)located in the extremities,22.2%(2/9 cases)located in the diaphysis,so there is no statistical significance(P = 0.090).Ewing’s sarcoma have 46.2%(6/13 cases)located in long bone,especially in diaphysis(5/6,83.3%),only 17%(1/6cases)located in the extremities;but PLB have 66.7%(6/9 cases)located in the extremities,22.2%(2/9 cases)located in the diaphysis,so there is no statistical significance(P = 0.103).Lesions of osteosarcoma mainly located in metaphysis or extremities of long bone(108/124,87.1%),and PLB have66.7%(6/9 cases)located in the extremities,but there is no statistical significance(P = 0.169);No tumor bone and periosteum reaction of osteosarcoma have 96%(24/25 cases)located in long bone,especially in metaphysis or extremities of long bone(20/24 cases,83.3%),there is no statistical significance(P = 0.625)compared with PLB(6/9 cases,66.7%).3 Imaging characteristics comparison3.1 Identification of PLB compared with SPB : The bone cortex of PLB has81.2%(13/16 cases)show varying degrees of destrution,but the bone cortex of SPB all have different degrees of destruction,they have statisticalsignificance(P = 0.024);most(26/37 cases,70.3%)lesions of SPB have dilatability change,most(20/32 cases,62.5%)lesions have residual bone crest,less expansion(3/16 cases,18.8%)and residual bone crest(2/13 cases,15.4%)of PLB lesions,and there are statistical significance(P = 0.001,P = 0.001).3.2 Identification of PLB compared with MFH: The bone cortex of MFH all have different degrees of destruction,and a few(6/20 cases,30%)in calcification lesions,but the bone cortex of PLB have 81.2%(13/16 cases)different degrees of destruction,and without calcification in the lesions,but there are no statistical significance(P = 0.061,P = 0.061).3.3 Identification of PLB compared with Ewing’s sarcoma: The bone cortex of Ewing’s sarcoma destruction is given priority to with invasive,mesh sample destruction(8/11 cases,72.7%),but most(11/13 cases,84.6%)PLB have cortical bone defect,there is statistical significance(P = 0.011).Ewing’s sarcoma have more periosteal reaction(9/13 cases,69.2%)and has statistical significance compared with PLB(1/16 cases,6.2%)(P = 0.001).3.4 Identification of PLB compared with osteosarcoma: More(54/84 cases,64.3%)osteosarcoma lesions have osteogenic bony destruction,there is statistical significance(P = 0.002)compared with PLB(2/12 cases,16.7%).Osteosarcoma have more tumor bone formation(71/92 cases,77.2%)and periosteal reaction(83/129 cases,64.3%),but no tumor bone formation or less periosteal reaction of PLB(1/16 cases,6.2%),so there are statistical significance(P = 0.000,P = 0.000).There are no statistical significance in the indexes between osteosarcoma which no tumor of bone and periosteum reaction and PLB.Conclusions:1 The peak onset age of SPB is 51 ~ 70(78.4%)which is close to PLB;SPB have more located in the axial skeleton(54.1%),while long bone is rare;the bone cortex of SPB all have varying degrees of destruction,more expansion lesions,most of the lesions have residual bone crest,less soft tissue mass and much mass are smaller.2 The peak onset age of MFH is 31~60(73.9%)which is less than PLB;more disease areas of MFH are located in the diaphysis of the long bone,while less are located in the extremities which is different from PLB;the bone cortex of MFH has varying degrees of destruction,have calcified lesions.3 The peak onset age of Ewing sarcoma is 11~20(53.8%)which is smaller than PLB;more disease areas of Ewing’s sarcoma are located in the diaphysis of the long bone which is different from PLB;the bone cortex destruction of Ewing’s sarcoma lighter than PLB,with more periosteal reaction and reactive osteogenesis inside the lesions of Ewing sarcoma.4 The peak onset age of osteosarcoma is 11~20(61.2%)smaller than PLB;the high risk regions of osteosarcoma are located in long bone metaphysis or bone end;more osteosarcoma lesions have osteogenic bony destruction,more tumor bone and periosteum reaction;there are no statistical significance in the indexes between osteosarcoma which no tumor of bone and periosteum reaction and PLB.