Multidisciplinary Clinical Case Study

Fibrin-Associated Diffuse Large B Cell Lymphoma Found on Revision Arthroplasty of the Knee

Authors: Jordan Hall, MD, Craig Kampfer, MD, Ned Williams, DO, Michael Osswald, MD, Bradie Bishop, MD, Misty Hall, MD, Joseph Alderete, MD


Fibrin-associated diffuse large B cell lymphoma (FA-DLBCL) is a rare Epstein-Barr viruspositive B cell lymphoma that is nonmass-forming, does not directly produce symptoms, and is incidentally discovered on histological examination of tissues excised for other reasons. Despite overlap in morphologic and immunophenotypic features with aggressive B cell neoplasms, FA-DLBCL shows an excellent clinical outcome, even with surgical excision alone. We report an extremely rare occurrence of FA-DLBCL found in association with a metallic implant on revision arthroplasty of the knee. This report also illustrates the need for an integrated multidisciplinary approach for accurate diagnosis and avoidance of overtreatment.

Posted in: Hematology10 Medical Oncology46

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Sharkey PF, Lichstein PM, Shen C, et al. Why are total knee arthroplasties failing today–has anything changed after 10 years? J Arthroplasty 2014;29: 1774–1778.
2. Bezwada HP, Shah AR, Zambito K, et al. Distal femoral allograft reconstruction for massive osteolytic bone loss in revision total knee arthroplasty. J Arthroplasty 2006;21:242–248.
3. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018;33:1309–1314.e2.
4. Angers-Goulet M, Pelet S, Belzile EL, et al. Total knee arthroplasty with distal femoral replacement is associated with an important complication rate. A case series. Knee 2019;26:1080–1087.
5. Cozzolino I, Rocco M, Villani G, et al. Lymph node fine-needle cytology of non-Hodgkin lymphoma: diagnosis and classification by flow cytometry. Acta Cytol 2016;60:302–314.
6. Gauci ML, Quero L, Ram-Wolff C, et al. Outcomes of radiation therapy of indolent cutaneous B-cell lymphomas and literature review. J Eur Acad Dermatol Venereol 2018;32:1668–1673.
7. De Felice F, Grapulin L, Pieroni A, et al. Radiation therapy in indolent primary cutaneous B cell lymphoma: a single institute experience. Ann Hematol 2018;97:2411–2416.
8. Tsang RW, Gospodarowicz MK. Low-grade non-hodgkin lymphomas. Semin Radiat Oncol 2007;17:198–205.
9. Tsang RW, Gospodarowicz MK. Radiation therapy for localized low-grade non-Hodgkin's lymphomas. Hematol Oncol 2005;23:10–17.
10. Sakata K, Satoh M, Someya M, et al. Analysis of local control in patients with non-Hodgkin's lymphoma according to the WHO classification. Strahlenther Onkol 2005;181:385–391.
11. Chan JKC, Aozasa K, Gaulard P. Diffuse large B cell lymphoma associated with chronic inflammation, in WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues, Swerdlow SH, Campo E, Harris NL, et al, eds. Lyon, France: International Agency for Research on Cancer; 2017:309–311.
12. Boyer DF, McKenzie PA, de Leval L, et al. Fibrin-associated EBV-positive large B-cell lymphoma: an indolent neoplasm with features distinct from diffuse large B-cell lymphoma associated with chronic inflammation. Am J Surg Pathol 2017;41:299–312.
13. CheukW, Chan ACL, Chan JKC, et al. 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.
14. Loong F, Chan ACL, Ho BCS, et al. Diffuse large B-cell lymphoma associated with chronic inflammation as an incidental finding and new clinical scenarios. Mod Pathol 2010;23:493–501.
15. Boroumand N, Ly TL, Sonstein J, et al. Microscopic diffuse large B-cell lymphoma (DLBCL) occurring in pseudocysts: do these tumors belong to the category of DLBCL associated with chronic inflammation? Am J Surg Pathol 2012;36:1074–1080.
16. King RL, Goodlad JR, Calaminici M, et al. Lymphomas arising in immuneprivileged sites: insights into biology, diagnosis, and pathogenesis. Virchows Arch 2020;476:647–665.
17. Hans CP, Weisenburger DD, Greiner TC, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 2004;103:275–282.
18. Kameda K, Shono T, Takagishi S, et al. Epstein-Barr virus-positive diffuse large B-cell primary central nervous system lymphoma associated with organized chronic subdural hematoma: a case report and review of the literature. Pathol Int 2015;65:138–143.
19. Alderete JF, Rock MG. Implant oncogenesis. In: Parvizi J, ed. The Knee. Towson, MD: Data Trace Publishing Company; 2012.
20. Chaudhry MS, Mather H, Marks A, et al. Diffuse large B cell lymphoma complicating total knee arthroplasty: case report and literature review of the association of diffuse large B cell lymphoma with joint replacement. Acta Haematol 2011;126:141–146.