Bone Pathology Database
|Text in Italics is general (instructional) information
The Chest X ray shows enlargement of the hilar lymph nodes and widening of the mediastinum. The lateral of the thoracic spine shows collapse of T12 with no loss of disc space. Plain X rays show vertebra plana ( "vertebra nigrans" ) of T12 with normal disc space. Magnetic resonance confirms the collapse of T12 with anterior bulging onto the spinal cord.
Management A thorocotomy was undertaken (skin clips from this procedure are seen in the middle X ray) and an anterior decompression of T12 was done. Biopsy showed sheets of larger cells, biopsy of an axillary node also showed this picture,as well as "hallmark" cells - a cell with a bean shaped nucleus were common. The final diagnosis was an anaplastic large cell (a T cell type ) lymphoma.
Vertebra plana is seen in:-
- Eosinophillic grannuloma
- Ewing's Sarcoma
Lymphomas can be divided into two groups Hodskins and
Non Hodskins (NHL) this is a case of Non Hodskin's Lymphoma
three types of NHL that occur most often in children are:
- lymphoblastic: Predominantly T-cell origin, sometimes hard
to distinguish from leukemia; 30% of childhood NHLs.
- small cell lymphoma (Burkitt's and non-Burkitt's):
- large cell lymphoma A heterogeneous group B lineage and
T lineage, some are like both T and B; 20-25% of childhood NHLs.
The appearance of large fields of uniform cells in the histology of this case,
had to be differentiated from Ewings or a PNET tumour
Facts about Non Hodskins Lymphoma
- 6% of childhood cancers,
- 1.0-1.5 per 100,000 children will be diagnosed with NHL
- more common in ages 10-20
- very unusual in children less than 3
- frequent malignancy in children with AIDS
Prognosis Glotzbecker (JBJS Vol88-A (3) Page 583)
"On the basis of 306 NHL lymphomas in children and a comprehensive review
of similar series in the literature involving
patients with primary lymphoma of bone, it appears that younger age, advanced-stage
disease, multiple-bone involvement,
and non-large-cell histology are associated with decreased survival as compared
with older age, localized
disease, single-bone involvement, and large-cell histology, respectively."