Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Diffuse Large B-Cell Lymphoma Associated with a Chronic Inflammatory Condition Induced by Metallic Implants: A Case Report

금속성 임플란트로 인한 만성 염증 상태와 연관된 미만성 거대 B세포 림프종: 증례 보고

  • Jin Hee Park (Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital) ;
  • Sun Joo Lee (Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital) ;
  • Hye Jung Choo (Department of Radiology, College of Medicine, Inje University, Busan Paik Hospital)
  • 박진희 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 이선주 (인제대학교 의과대학 부산백병원 영상의학과) ;
  • 추혜정 (인제대학교 의과대학 부산백병원 영상의학과)
  • Received : 2021.08.13
  • Accepted : 2021.12.14
  • Published : 2022.07.01
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Abstract

Chronic inflammatory condition associated with metallic implant insertion is a risk factor for diffuse large B-cell lymphoma (DLBCL). Metal ions play a role in the pathogenesis of lymphoma. We report a rare case of DLBCL in a patient who had a metallic implant in the proximal tibia for 15 months. Radiologic studies, including US and MRI, showed disproportionately large extraosseous soft-tissue mass and bone marrow involvement without prominent bone destruction. Multiple complications are associated with metallic implants, and misdiagnosis may lead to inappropriate treatment. Therefore, distinguishing lymphomas caused by a metallic implant-induced chronic inflammatory condition from other periprosthetic benign lesions and malignant soft tissue masses is challenging, but it is critical.

금속성 임플란트 삽입과 관련된 만성 염증 상태는 미만성 거대 B세포 림프종 발생의 위험 요소이다. 금속 이온은 림프종의 발병에 중요한 역할을 하는 것으로 알려져 있다. 저자들은 15개월 동안 근위 경골에 금속성 임플란트가 삽입된 환자에서 발생한 드문 미만성 거대 B세포 림프종 증례를 보고하고자 한다. 초음파 및 자기공명영상을 촬영하였으며 현저한 골 파괴 없이 불균형적으로 큰 골외 연조직 종괴와 골수 침범이 관찰되었다. 금속성 임플란트 삽입과 관련된 여러 합병증들이 있으며 오진하면 잘못된 치료로 이어질 수 있다. 따라서 금속성 임플란트로 인한 만성 염증 상태와 연관된 림프종과 임플란트 주위에 발생할 수 있는 다른 양성 병변 및 악성 연조직 종괴를 감별하는 것은 어렵지만 매우 중요하다.

Keywords

References

  1. Sanchez-Gonzalez B, Garcia M, Montserrat F, Sanchez M, Angona A, Solano A, et al. Diffuse large B-cell lymphoma associated with chronic inflammation in metallic implant. J Clin Oncol 2013;31:e148-e151
  2. King RL, Goodlad JR, Calaminici M, Dotlic S, Montes-Moreno S, Oschlies I, et al. Lymphomas arising in immune-privileged sites: insights into biology, diagnosis, and pathogenesis. Virchows Arch 2020;476:647-665
  3. Wang SJ, Cao DL, Xu HW, Zhao WD, Hu T, Wu DS. Development of primary diffuse large B-cell lymphoma around an internal fixation implant after lumbar fusion surgery: a case report and review of the literature. World Neurosurg 2020;137:140-145
  4. Coen N, Kadhim MA, Wright EG, Case CP, Mothersill CE. Particulate debris from a titanium metal prosthesis induces genomic instability in primary human fibroblast cells. Br J Cancer 2003;88:548-552
  5. Ladon D, Doherty A, Newson R, Turner J, Bhamra M, Case CP. Changes in metal levels and chromosome aberrations in the peripheral blood of patients after metal-on-metal hip arthroplasty. J Arthroplasty 2004;19:78-83
  6. Sarhadi VK, Parkkinen J, Reito A, Nieminen J, Porkka N, Wirtanen T, et al. Genetic alterations in periprosthetic soft-tissue masses from patients with metal-on-metal hip replacement. Mutat Res 2015;781:1-6
  7. Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics 2003;23:1371-1383; discussion 1384-1387
  8. Cheuk W, Chan AC, Chan JK, Lau GT, Chan VN, Yiu HH. Metallic implant-associated lymphoma: a distinct subgroup of large B-cell lymphoma related to pyothorax-associated lymphoma? Am J Surg Pathol 2005;29:832-836
  9. Rajeev A, Ralte A, Choudhry N, Jabbar F, Banaszkiewicz P. Diffuse B cell non-Hodgkin's lymphoma presenting atypically as periprosthetic joint infection in a total hip replacement. Case Rep Orthop 2017;2017:7195016
  10. Awan O, Chen L, Resnik CS. Imaging evaluation of complications of hip arthroplasty: review of current concepts and imaging findings. Can Assoc Radiol J 2013;64:306-313