World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Case Report

Volume 10, Number 4-5, October 2019, pages 181-185

Primary Synovial Diffuse Large B-Cell Lymphoma Presenting as Loosening of Prosthetic Joint: A Case Report and Review of Literature

Figure 1. Low power (× 20) image showing the reactive thick fibrosynovial tissue within the knee joint, with associated giant cell reaction to cement (top of picture) with the atypical subjacent diffuse mononuclear cell infiltrate. The differential includes both reactive/infectious conditions and malignancy.

Figure 2. High power (× 400) image showing the diffuse infiltrate of large lymphoma cells with admixed histiocytes, mitosis and karyorrhexis debris.

Figure 3. Low power (× 40) image of CD20 immunohistochemical stain confirming the morphologic suspicion of diffuse large B-cell lymphoma.

**Table 1.** Literature Review of Cases of Primary Synovial NHL (1980 to Present)
Author	Publication year	Age/sex	Joints involved at presentation	Significant past medical history	Systemic complaints (fever, night sweats, weight loss)	Lymphadenopathy at presentation	Hepatosplenomegaly at presentation	Imaging findings	Gross appearance of biopsy tissue	Diagnosis
NR: not reported; MRI: magnetic resonance imaging; US: ultrasound.
Tiwari et al [13]	1982	76/F	Left knee	No	Night sweats, weight loss	Left inguinal	No	X-ray: no abnormality noted.	Synovial thickening	Diffuse NHL
Dorfman et al [1]	1986	48/F	Left knee	None	Fatigue, fever	No	No	X-ray: non-calcified soft tissue mass in the suprapatellar bursa	Tan, firm, homogeneous, friable	Malignant lymphoma of histiocytic type
Dorfman et al [1]	1986	72/M	Left knee	Rheumatoid arthritis, gout	No	No	No	X-ray: marked narrowing of joint space, hypertrophic marginal lipping in the distal femur and proximal tibia.	Marked erosion of articular cartilage, surrounding osteophyte formation	Malignant lymphoma of non-Hodgkin’s type
Hasse et al [16]	1990	36/F	Left knee	Right axilla immunoblastic lymphoma treated with local radiation only (11 years ago)	No	No	No	X-ray: no abnormality noted.	Mass originating from synovial membrane infiltrating into periosteum of femoral condyles and gastrocnemius muscles	Malignant B-cell immunoblastic lymphoma
Bagga et al [15]	1996	39/F	Right knee	Renal transplant secondary to glomerulonephritis, right knee replacement for avascular necrosis 4 years ago	NR	NR	NR	X-ray: a lesion at the posterior aspect of right proximal tibia with small effusion. Three-phase bone scan: increased uptake at periprosthetic region.	NR	DLBCL
Peeva et al [14]	1999	27/M	Right knee	HIV	Weight loss	No	No	X-ray: permeative pattern of femoral metaphysis, periosteal reaction and effusion. MRI: heterogenous marrow inflammation, hypertrophic synovial changes, patchy cortical destruction, distributed effusion	NR	DLBCL
Birlik et al [18]	2003	69/F	Right fourth finger	No	No	No	No	X-ray: destruction of proximal phalanx of fourth finger, soft tissue swelling.	NR	Articular B-cell lymphoma
Khan et al [12]	2004	65/M	Left knee	Ankylosing spondylitis	No	No	No	X-ray: bony destruction with large effusion. MRI: bony erosion, gross synovial hypertrophy, 3 cm mass seen posterior to the femur.	NR	DLBCL
Jawa et al [7]	2006	33/M	Right elbow	Hyperextension injury of right elbow	No	No	No	X-ray: no abnormality noted.	Fleshy, tan	DLBCL
Chim et al [11]	2006	66/M	Left knee	Seronegative rheumatoid arthritis on methotrexate	No	No	No	US: heterogenous soft tissue mass lesion in left knee, predominantly in suprapatellar bursa and anterior joint compartment.	NR	DLBCL
Neri et al [6]	2010	58/M	Left elbow	None	No	No	No	X-ray/US: erosion of lateral epicondyle. MRI: extensive ill-defined bone marrow signal intensity affecting distal portion of humerus. A synovial effusion with a solid component was detected.	Hemorrhagic synovial tissue	DLBCL
Visser et al [8]	2012	69/F	Left knee	Seronegative rheumatoid arthritis, right knee replacement	No	No	No	X-ray: severe lateral osteoarthritis of the left knee with loss of height of the lateral tibial plateau.	Pigmented vitreous tissue	DLBCL-NOS
George et al [9]	2013	68/M	Left subtalar and talonavicular	Rheumatoid arthritis	No	No	No	X-ray: osteoarthritis of subtalar and talonavicular joint. US: marked synovitis in the subtalar joint.	Hypertrophied, dark synovium	DLBCL

Table 1. Literature Review of Cases of Primary Synovial NHL (1980 to Present)

Author

Publication year

Age/sex

Joints involved at presentation

Significant past medical history

Systemic complaints (fever, night sweats, weight loss)

Lymphadenopathy at presentation

Hepatosplenomegaly at presentation

Imaging findings

Gross appearance of biopsy tissue

Diagnosis

NR: not reported; MRI: magnetic resonance imaging; US: ultrasound.

Tiwari et al [13]

1982

76/F

Left knee

Night sweats, weight loss

Left inguinal

X-ray: no abnormality noted.

Synovial thickening

Diffuse NHL

Dorfman et al [1]

1986

48/F

Left knee

None

Fatigue, fever

X-ray: non-calcified soft tissue mass in the suprapatellar bursa

Tan, firm, homogeneous, friable

Malignant lymphoma of histiocytic type

Dorfman et al [1]

1986

72/M

Left knee

Rheumatoid arthritis, gout

X-ray: marked narrowing of joint space, hypertrophic marginal lipping in the distal femur and proximal tibia.

Marked erosion of articular cartilage, surrounding osteophyte formation

Malignant lymphoma of non-Hodgkin’s type

Hasse et al [16]

1990

36/F

Left knee

Right axilla immunoblastic lymphoma treated with local radiation only (11 years ago)

X-ray: no abnormality noted.

Mass originating from synovial membrane infiltrating into periosteum of femoral condyles and gastrocnemius muscles

Malignant B-cell immunoblastic lymphoma

Bagga et al [15]

1996

39/F

Right knee

Renal transplant secondary to glomerulonephritis, right knee replacement for avascular necrosis 4 years ago

X-ray: a lesion at the posterior aspect of right proximal tibia with small effusion. Three-phase bone scan: increased uptake at periprosthetic region.

DLBCL

Peeva et al [14]

1999

27/M

Right knee

HIV

Weight loss

X-ray: permeative pattern of femoral metaphysis, periosteal reaction and effusion. MRI: heterogenous marrow inflammation, hypertrophic synovial changes, patchy cortical destruction, distributed effusion

DLBCL

Birlik et al [18]

2003

69/F

Right fourth finger

X-ray: destruction of proximal phalanx of fourth finger, soft tissue swelling.

Articular B-cell lymphoma

Khan et al [12]

2004

65/M

Left knee

Ankylosing spondylitis

X-ray: bony destruction with large effusion. MRI: bony erosion, gross synovial hypertrophy, 3 cm mass seen posterior to the femur.

DLBCL

Jawa et al [7]

2006

33/M

Right elbow

Hyperextension injury of right elbow

X-ray: no abnormality noted.

Fleshy, tan

DLBCL

Chim et al [11]

2006

66/M

Left knee

Seronegative rheumatoid arthritis on methotrexate

US: heterogenous soft tissue mass lesion in left knee, predominantly in suprapatellar bursa and anterior joint compartment.

DLBCL

Neri et al [6]

2010

58/M

Left elbow

None

X-ray/US: erosion of lateral epicondyle.
MRI: extensive ill-defined bone marrow signal intensity affecting distal portion of humerus. A synovial effusion with a solid component was detected.

Hemorrhagic synovial tissue

DLBCL

Visser et al [8]

2012

69/F

Left knee

Seronegative rheumatoid arthritis, right knee replacement

X-ray: severe lateral osteoarthritis of the left knee with loss of height of the lateral tibial plateau.

Pigmented vitreous tissue

DLBCL-NOS

George et al [9]

2013

68/M

Left subtalar and talonavicular

Rheumatoid arthritis

X-ray: osteoarthritis of subtalar and talonavicular joint. US: marked synovitis in the subtalar joint.

Hypertrophied, dark synovium

DLBCL