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

Abstract

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

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References

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.