Primary multifocal osseous Hodgkin lymphoma

A 28-year-old Japanese man presented with a 14-month history of right pelvic and lumbar pain. Despite normal findings on X-ray and CT scan at a previous hospital, sternal tumor had arisen and fever, night sweat, and weight loss developed 5 months before admission. Core needle biopsy of the sternal tumor was performed and a diagnosis of Hodgkin lymphoma (HL) (mixed cellularity) was made. FDG-PET scan demonstrated increased FDG uptake in the sternum, the right ilium, the right 9(th) rib, and the lower edge of the left scapula, but there were no other apparent lesions. Neither bone marrow biopsy nor cerebrospinal fluid examination showed infiltration of lymphoma cells. ABVD was started and the symptoms resolved immediately. After 6 cycles of ABVD, the patient achieved complete remission and local radiotherapy for the right ilium was added. Primary osseous HL confined to the bone is so rare that only 16 cases have been reported worldwide to date, with none of these cases being from Japan. Since there have not yet been any characteristic symptoms or laboratory findings identified, the diagnosis of osseous HL is difficult and may be delayed. Although systemic chemotherapy appears to have been effective in the reported cases, more cases should be reviewed to clarify its pathophysiological features.