Major patient clinical features organized by musculoskeletal or immunological/hematological abnormalities
| Musculoskeletal . | Immunological/hematological . |
|---|---|
| Contractures of upper limb joints, hips, knees, and ankles | Age 18 yr: B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and cHL•Widespread lymphadenopathy: abdominal, inguinal, hepatic, splenic, paratracheal, subcarinal, bone; no bone marrow involvement•Lymph node tissue demonstrates malignant large mono- or binucleated cells within a benign background inflammatory cell infiltrate composed of small lymphocytes, eosinophils, histiocytes, and neutrophils•Lymph node: effaced/abnormal architecture, large atypical CD79a+CD30+CD20+CD15−PAX5+ B cells, positive BCL6 rearrangement, negative BCL2 rearrangement |
| Mobility issues: stiff gait, decreased stride length, and toe walking | |
| Decreased arm swing and knee range of motion. Anterior pelvic tilt with adduction of thighs | |
| Ill-defined sclerotic bands present in the metaphyses of femoral tibia and fibula | |
| Presence of multiple small pedunculated osteochondromas | Age 21 yr: mature B cell lymphoma, subtype: Burkitt lymphoma•Supra- and infradiaphragmatic lymphadenopathy with splenic and marrow involvement•Lymph node: effaced architecture, monomorphic medium-large size cell lymphoid population with prominent nucleoli in chromocenters and CD20+ CD79a+CD10dimKi67+CD30−•Positive for the translocation (8;14)(q24;q32) resulting in IGH-MYC fusion |
| Developed severe spinal cord stenosis at level C3 C4, requiring posterior cervical decompression and fusion | |
| Bone density scan (DEXA):Lumbar spine L1-4: 0.739 (g/cm2); Z-score for chronologic age: −1.4; Z-score corrected for height: +0.2Total left hip: 0.865 (g/cm2); Z-score for chronological age 1.0; Z-score corrected for height: +0.2Total body: 0.888 (g/cm2); Z-score for chronologic age: −1.9; Z-score corrected for height: −0.4 | |
| No evidence of muscle necrosis or regeneration, no increased endomysia fibrous tissue, no inflammation, and no atypical cells | Detectable serum IgG against: cytomegalovirus, EBV capsid, Herpes simplex virus, and Rubella virus |
| Musculoskeletal . | Immunological/hematological . |
|---|---|
| Contractures of upper limb joints, hips, knees, and ankles | Age 18 yr: B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and cHL•Widespread lymphadenopathy: abdominal, inguinal, hepatic, splenic, paratracheal, subcarinal, bone; no bone marrow involvement•Lymph node tissue demonstrates malignant large mono- or binucleated cells within a benign background inflammatory cell infiltrate composed of small lymphocytes, eosinophils, histiocytes, and neutrophils•Lymph node: effaced/abnormal architecture, large atypical CD79a+CD30+CD20+CD15−PAX5+ B cells, positive BCL6 rearrangement, negative BCL2 rearrangement |
| Mobility issues: stiff gait, decreased stride length, and toe walking | |
| Decreased arm swing and knee range of motion. Anterior pelvic tilt with adduction of thighs | |
| Ill-defined sclerotic bands present in the metaphyses of femoral tibia and fibula | |
| Presence of multiple small pedunculated osteochondromas | Age 21 yr: mature B cell lymphoma, subtype: Burkitt lymphoma•Supra- and infradiaphragmatic lymphadenopathy with splenic and marrow involvement•Lymph node: effaced architecture, monomorphic medium-large size cell lymphoid population with prominent nucleoli in chromocenters and CD20+ CD79a+CD10dimKi67+CD30−•Positive for the translocation (8;14)(q24;q32) resulting in IGH-MYC fusion |
| Developed severe spinal cord stenosis at level C3 C4, requiring posterior cervical decompression and fusion | |
| Bone density scan (DEXA):Lumbar spine L1-4: 0.739 (g/cm2); Z-score for chronologic age: −1.4; Z-score corrected for height: +0.2Total left hip: 0.865 (g/cm2); Z-score for chronological age 1.0; Z-score corrected for height: +0.2Total body: 0.888 (g/cm2); Z-score for chronologic age: −1.9; Z-score corrected for height: −0.4 | |
| No evidence of muscle necrosis or regeneration, no increased endomysia fibrous tissue, no inflammation, and no atypical cells | Detectable serum IgG against: cytomegalovirus, EBV capsid, Herpes simplex virus, and Rubella virus |
cHL, classic Hodgkin lymphoma; DLBCL, diffuse large B-cell lymphoma; DEXA, dual-energy X-ray absorptiometry; EBV, Epstein-Barr virus.