Primary non-Hodgkin lymphoma of the bone

Sir, I read with great interest the recent case report by Ronald et al., about an unusual presentation of primary non-Hodgkin lymphoma.[1] I congratulate the authors for presenting this case report in a very effective way. I want to explain some more facts about primary bone lymphoma to enhance the interest of the readers. Male predominance, higher likelihood of early stage presentation, and a median age predominance of the fifth or sixth decade are usual features of primary bone lymphoma.[2] Primary lymphoma of the bone also known as reticulum cell sarcoma, malignant lymphoma of the bone, and more recently osteolymphoma usually manifests with insidious and intermittent bone pain that can persist for many months. Other signs and symptoms include local swelling, palpable mass, and systemic features like weight loss and fever. Although boney involvement of disseminated malignant lymphoma is not uncommon, primary lymphoma of bone is infrequent. Primary bone lymphoma is mostly large-cell or mixed small- and large-cell lymphoma of the B-cell lineage.[3] It usually affects the long bones, indeed its very unusual presentation in this case report where it affects the proximal phalanx of the right thumb. On the basis of radiological characteristics, primary bone lymphoma can be divided into three groups: (1) lytic destructive pattern, (2) blastic sclerotic pattern, and (3) subtle or near-normal pattern.[3] In general, limb-sparing radiation therapy was considered as the gold standard in 1960s with a curing rate of 44-63%. But now patients with monostatic primary bone lymphoma treated with a combination of radiation therapy and chemotherapy do well.[2]