Hodgkin lymphoma (musculoskeletal manifestations)

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Hodgkin lymphoma (HL) commonly involves the musculoskeletal system, being radiographically evident in 10-25% of cases at some point during the disease course. The majority of early bone lesions are lytic, however, blastic lesions are common (up to 45%).

Pathology

Osseous involvement may occur via hematogenous or lymphatic spread, with direct extension from an adjacent lymph node being the most common route, carrying a better prognosis than hematogenous spread.

Location

Any skeletal site may be involved, however, the most common regions include the spine, pelvis, ribs, femur, and sternum.

  • spine: most commonly involved site in Hodgkin lymphoma
    • erosion of anterior or anterolateral aspect of the vertebral body(ies) is a classic finding in HL, caused by enlarged paravertebral lymph nodes
    • nodular sclerosing HL shows diffusely increased density with our without anterior erosion; vertebral body height is unaffected
    • single, dense vertebra (ivory vertebra) in adults is suggestive of HL, however, it has many other causes
    • intervertebral disc spaces are generally unaffected by the disease
  • pelvis: mixed or sclerosing type predominates
  • ribs: may be osteolytic and expansile
  • sternum
  • long bones:  frequently lytic, extending along the long axis of bone through the medullary cavity with endosteal scalloping of the cortex