TY - JOUR
T1 - Unexpected primary extranodal marginal zone lymphoma of bone in amputation and arthroplasty specimens
AU - Diaz-Perez, Julio A.
AU - Poveda, Julio C.
AU - Chapman, Jennifer R.
AU - Velez-Torres, Jaylou M.
AU - Vega, Francisco
AU - Rosenberg, Andrew E.
N1 - Publisher Copyright:
© 2021 American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: Journals.permissions@oup.com.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Objectives: Amputation due to gangrene and arthroplasty for degenerative joint disease are common orthopedic procedures and are expected to increase as populations age. Histopathologic examination of these specimens can identify unsuspected diseases. Methods: We reviewed gangrenous amputations and large joint arthroplasty specimens for diagnosis of unexpected lymphoma, January 2014 to January 2020. Pathology and medical records were reviewed to determine diagnosis, treatment, and outcome. Results: Five cases (0.08%) of unexpected primary extranodal marginal zone lymphoma (MZL) centered in bone were identified in 1,624 amputations for gangrene and 4,163 arthroplasty specimens. The female-to-male distribution was 3:2. Median age was 71 years (range, 62-87). The 3 cases arising in the setting of gangrene involved the first toe phalanges and metatarsals, and the femoral head was involved in all cases of joint disease (2 cases). The bone showed variable (10%-80%) infiltration by dense populations of small lymphoid cells with MZL immunophenotype. One patient died from sepsis 18.5 months after diagnosis; all others are alive with a median follow-up of 27.45 months. Conclusions: Histopathologic examination of nonneoplastic orthopedic specimens identifies unexpected primary bone extranodal MZL in a small percentage of cases. This neoplasm may be the result of chronic antigenic stimulation in some circumstances.
AB - Objectives: Amputation due to gangrene and arthroplasty for degenerative joint disease are common orthopedic procedures and are expected to increase as populations age. Histopathologic examination of these specimens can identify unsuspected diseases. Methods: We reviewed gangrenous amputations and large joint arthroplasty specimens for diagnosis of unexpected lymphoma, January 2014 to January 2020. Pathology and medical records were reviewed to determine diagnosis, treatment, and outcome. Results: Five cases (0.08%) of unexpected primary extranodal marginal zone lymphoma (MZL) centered in bone were identified in 1,624 amputations for gangrene and 4,163 arthroplasty specimens. The female-to-male distribution was 3:2. Median age was 71 years (range, 62-87). The 3 cases arising in the setting of gangrene involved the first toe phalanges and metatarsals, and the femoral head was involved in all cases of joint disease (2 cases). The bone showed variable (10%-80%) infiltration by dense populations of small lymphoid cells with MZL immunophenotype. One patient died from sepsis 18.5 months after diagnosis; all others are alive with a median follow-up of 27.45 months. Conclusions: Histopathologic examination of nonneoplastic orthopedic specimens identifies unexpected primary bone extranodal MZL in a small percentage of cases. This neoplasm may be the result of chronic antigenic stimulation in some circumstances.
KW - Amputation
KW - Arthroplasty
KW - Bone neoplasms
KW - Incidental findings
KW - Marginal zone lymphoma
KW - Osteoarthrosis
KW - Osteomyelitis
UR - http://www.scopus.com/inward/record.url?scp=85120438473&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120438473&partnerID=8YFLogxK
U2 - 10.1093/ajcp/aqab067
DO - 10.1093/ajcp/aqab067
M3 - Review article
C2 - 34075398
AN - SCOPUS:85120438473
SN - 0002-9173
VL - 156
SP - 1038
EP - 1043
JO - American journal of clinical pathology
JF - American journal of clinical pathology
IS - 6
ER -