A RARE CASE OF LYMPHOMA OF ILIUM A DIAGNOSTIC DILEMMA

Primary bone lymphoma represents approximately 3 of all malignant bone tumours and 5 of all non Hodgkin lymphoma. A 65 yrs old gentleman from Easterm India presented with 3 month history continuous dull aching pain in left iliac region radiating to left thigh. Initial examination revealed a 34 cm tender swelling with indistinct margin localized over the lateral portion of the left iliac crest region. A needle biopsy was performed. The histopathological analysis showed non - specific chronic osteomyelities. The culture sentivity showed no growth. In view of biopsy report he was started on broad spectrum antibiotics for 8 weeks. Patient came back after 8 months for follow up. He was pale, cachexic and had significant loss of weight .On examination the swelling had increased to size of 1010 cm soft tissue mass present in left iliac region extending up to inguinal region. A repeat open biopsy done which revealed scanty high grade B cell Non Hodgkin lymphoma, biopsy left Ilium. Medical oncology opinion was obtained and the tumor staged as Ann Arbor Ia Extra nodal, with risk stratification of low intermediate. To our knowledge, this is the first report of an innominate bone lymphoma in India. This has been reported due to the unusual location of this tumor, the ambiguity in clinical symptoms and the diagnostic dilemma thus caused.