Primary lymphoma of the tibia in children: Two case reports

Medicine (Baltimore). 2020 Jan;99(4):e18807. doi: 10.1097/MD.0000000000018807.


Rationale: Primary lymphoma of the bones (PLB) is a rare extranodal non-Hodgkin lymphoma (NHL) that is particularly rare in children. The clinical presentation and radiological features of PLB are often nonspecific, making clinical diagnosis challenging and misdiagnosis frequent. Here, we report 2 children with PLB focusing on clinical presentation, differential diagnosis, and treatment outcomes.

Patients concerns: A 9-year-old boy presented with left knee swelling and pain for 4 months after a fall. He was previously misdiagnosed with traumatic soft tissue injury. The second patient was an 11-year-old boy with a 6-month history of intermittent left knee pain. He was previously misdiagnosed with bone tuberculosis and chronic osteomyelitis.

Diagnoses: A 9-year-old boy showed an abnormal signal of the left tibia metaphysis, diaphysis, and epiphysis, and tibia with periosteal reactions and surrounding soft tissue swelling. Tumor biopsy and immunohistochemistry confirmed a diagnosis of B-cell lymphoblastic lymphoma.An 11-year-old boy showed a permeative lesion in the metaphysis and diaphysis of the left proximal tibia. Tumor biopsy and immunohistochemistry confirmed the diagnosis of diffuse large B-cell lymphoma.

Interventions: Both patients were treated with 6 courses of NHL-Berlin-Frankfurt-Münster-95.

Outcomes: Both patients are in complete clinical remission with a follow-up of 27 and 18months after treatment, respectively.

Lessons: PLB is a rare malignancy that is difficult to diagnose, particularly in children. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Chemotherapy combined with radiotherapy is a favorable treatment for children with PLB. Early diagnosis and active treatment can improve patient prognosis.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Asparaginase / therapeutic use
  • Child
  • Cyclophosphamide / therapeutic use
  • Cytarabine / therapeutic use
  • Dexamethasone / therapeutic use
  • Doxorubicin / therapeutic use
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / diagnostic imaging
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Lymphoma, Non-Hodgkin / diagnostic imaging
  • Lymphoma, Non-Hodgkin / drug therapy
  • Lymphoma, Non-Hodgkin / pathology*
  • Magnetic Resonance Imaging
  • Male
  • Positron Emission Tomography Computed Tomography
  • Remission Induction
  • Thioguanine / therapeutic use
  • Tibia / diagnostic imaging
  • Tibia / pathology*
  • Vincristine / therapeutic use


  • Cytarabine
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Asparaginase
  • Thioguanine

Supplementary concepts

  • Berlin-Frankfurt-Muenster protocol II