[Lymphomas presenting as Tietze's syndrome: a report of 4 clinical cases]

We describe 4 cases of malignant lymphoma (3 women, 1 man, age range 20-49 years) presenting with a tender and fusiform swelling at the level of the upper costosternal joints, with the clinical characteristics of classic Tietze's syndrome. Physical examination, laboratory findings and chest X-rays all were negative, while telethermography examination evidenced an area of hyperthermia at the level of the swelling in the chondrosternal region. Tietze's syndrome was diagnosed and the patients were treated with non-steroidal anti-inflammatory drugs and a local injection of corticosteroid. The clinical picture did not change, and in 2 cases a cervical lymphadenopathy developed. A biopsy of the lymph nodes and articular tumefaction disclosed Hodgkin's disease in 3 cases and non-Hodgkin's lymphoma in 1 case. Computerized tomography, lymphography and bone marrow biopsy permitted the complete staging of the lymphoma. After beginning a therapeutic program with chemotherapy and irradiation therapy, all 4 patients underwent complete remission.