Primary Solitary Osseous Hodgkin's Lymphoma: A Case Report and Review of the Literature

Dear Editor, Herein we report a case of primary Hodgkin's lymphoma (HL) of the scapula presented with shoulder pain. A 24-year-old young and healthy man presented with left shoulder pain and swelling. There was no evidence of weight loss, sweating, fever or any systemic symptoms. Laboratory evaluation was normal except for mild leukocytosis. C-reactive protein was negative and erythrocyte sedimentation was normal. Physical examination showed mild shoulder limitation of motion secondary to pain and swelling due to ill-defined mass. No peripheral lymphadenopathy was detected despite of thorough examination of the whole body. Plain X-ray showed an osteolytic lesion in the scapula. Magnetic resonance imaging (MRI) showed diffuse abnormal signal in the scapula and the coracoid process. There were soft tissue masses on both sides of spine of scapula indicating origin from the bone. Head of humerus was unremarkable (Figure 1). With the radiologic differential diagnoses of neoplastic process, the patient underwent open surgery to obtain an excisional biopsy. Pathologic examination of the biopsy showed diffuse infiltration of polymorphic population of hematopoietic cells composed of eosinophils, plasma cells, lymphocytes, PMN leukocytes and foamy histiocytes. There were many isolated mono and binucleated large Reed-Sternberg cells which were reactive with CD15, CD30 and Pax-5, but nonreactive with LCA, EMA and ALK (Figure 2 and 3a and 3b).