Bilateral tibial lesions as an onset of the diffuse В-cellular non-Hodgkin lymphoma

BACKGROUND: Diffuse В-cellular non-Hodgkin lymphoma is the most widespread in this group of diseases, causing the highest number of lymphoma-related lethal outcomes worldwide. The clinical-pathological heterogeneity of the nosology negatively affects the possibilities of precise and timely diagnostics. The variety of extranodal locations of the disease requires the participation of a multidisciplinary team of high qualification specialists, the use of high-tech methods for diagnostics and the aggressive therapy. The article presents a discussion on the occurrence of the diffuse В-cellular non-Hodgkin lymphoma, on the rates of an onset with the lesions in the skeleton, on the specific features of the disease course that is mimicking the rheumatic disease, as well as on the difficulties of recognizing it due to the absence of specific symptoms at the beginning of the disease and to the necessity of using high-tech instrumental diagnostic methods. Clinical case description: The article presents a clinical case of the patient aged 57 years, hospitalized to the Regional Tuberculosis Dispensary with the provisional diagnosis of tuberculosis-associated arthritis of the ankle joints. At the out-patient phase, the differential diagnostics was conducted between the inflammatory disease of the joints, the trauma, the bone tuberculosis and the orthopedic abnormalities. The radiology image of the chest cavity organs showed the presence of diffuse pneumosclerosis, according to the data from multispiral computed tomography, a cystic transformation was found along with the space-occupying mass lesions and osteolysis in the distal areas of both tibial bones. Based on the results of the histological examination of the lower third of the left tibia, a diagnosis of diffuse В-cellular non-Hodgkin lymphoma with high proliferative activity was set, confirmed at the specialized medical institution using the method for calculating the IPI prognostic index (International Prognostic Index). Conclusion: The presented case demonstrates the necessity for oncological alertness and for multidisciplinary approach for ruling out the primary and the secondary non-Hodgkin lymphomas of bone tissue location, mimicking the bilateral disease of the joints, for the purpose of early diagnostics and timely treatment, improving the prognosis for patients with this group of diseases.