Abstract
Introduction:
Skeletal involvement in non-Hodgkin lymphoma in HIV/AIDS is rarely reported. The bone lesions can have a spectrum of radiological features.
Aims:
The aim of the study was to review the radiological features of non-Hodgkin lymphoma (NHL) involving the bone in HIV positive patients.
Methodology:
All cases of NHL involving bone in HIV positive patients diagnosed histopathologically were recorded retrospectively between September 2002 and December 2013. Clinical manifestations, radiological features and haematological investigations were analysed from the patients' records. Histopathological subtypes were analysed from slides.
Results:
105 Cases of lymphoma involving bone were recorded. Of these, 46 patients met the criteria of being HIV positive and diagnosed with NHL involving bone. The male to female ratio was equal, the age ranged from 14 to 51 years (average 35 years), the absolute CD 4 count ranged from 17 to 307 (average 100).
The sites of involvement were:- vertebrae (22), ribs (8), pelvis (6), femur (3), mandible (3), humerus (2), sternum (1) and clavicle (1). Vertebral involvement was multifocal with a large extradural soft tissue mass in 17 cases and solitary in 5 cases. Pathological fractures were seen in 4 cases of long bone involvement. Most patients presented with a high grade large B cell non-Hodgkin lymphoma with CD20 immunopositivity.
Conclusion:
Primary bone lymphoma is a rare disease, accounting for approximately 3% of all primary bone malignancies and 4% to 7% of all extranodal lymphomas in the general population. The prevalence of primary and secondary bone lymphoma is very high in HIV positive patients. The disease is very aggressive, presenting in patients with low CD 4 count and the prognosis is poor. The radiologic patterns can be lytic, blastic or subtle changes, solitary or multifocal. The diagnosis of skeletal NHL is made on histopathology.
