[Primary multifocal osseous Hodgkin lymphoma].

Area of Science:

• Oncology
• Hematology
• Radiology

Background:

• Primary osseous Hodgkin lymphoma (HL) is an exceptionally rare condition, with limited reported cases globally.
• Diagnosis can be challenging due to non-specific symptoms and normal initial imaging findings.

Observation:

• A 28-year-old Japanese male presented with prolonged pelvic and lumbar pain, later developing a sternal tumor with B symptoms (fever, night sweats, weight loss).
• Initial X-ray and CT scans were unremarkable, but a core needle biopsy confirmed mixed cellularity Hodgkin lymphoma.
• FDG-PET imaging revealed uptake in the sternum, ilium, rib, and scapula, indicating bone involvement without other apparent lesions.

Findings:

• Systemic chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) led to immediate symptom resolution and complete remission after 6 cycles.
• The patient received additional local radiotherapy to the affected ilium for consolidation.
• This case represents the first reported instance of primary osseous HL in Japan.

Implications:

• The rarity and diagnostic difficulty of osseous HL underscore the importance of considering this diagnosis in patients with unexplained bone pain and systemic symptoms.
• Effective treatment with chemotherapy and radiotherapy suggests a potential therapeutic strategy, though further case reviews are needed.
• Clarifying the pathophysiological features of osseous HL is crucial for improving diagnostic accuracy and treatment outcomes.