Supplementary Material for: Polyostotic Fibrous Dysplasia Mimicking Bone Involvement in Hodgkin Lymphoma: A Pediatric Case and Literature Review

Bone involvement in Hodgkin lymphoma (HL) is rare. The differential diagnosis between HL bone localization and other malignant or benign skeletal diseases is challenging. We report the case of a girl affected by classic HL, initially staged IVA because of supradiaphragmatic lymph nodes and skeletal involvement. After 6 ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) cycles, positron emission tomography (PET) showed a complete metabolic response of the nodal localizations and a persistent, high metabolic activity of bone lesions. Salvage treatment followed by autologous stem cell transplant was carried out. After the transplant, the bone lesions maintained a high metabolic activity at PET. A targeted bone biopsy led to the diagnosis of a fibrous dysplasia excluding the presence of HL. To our knowledge, the concomitant presence of HL and fibrous dysplasia has not been previously reported. An in-depth evaluation of disease response to frontline treatment with a biopsy of the PET-hypercaptant bone lesions could have avoided overtreatment in this patient.

霍奇金淋巴瘤（Hodgkin lymphoma, HL）的骨骼受累较为罕见。霍奇金淋巴瘤骨骼病灶与其他恶性或良性骨骼疾病的鉴别诊断颇具挑战。本文报告1例经典型霍奇金淋巴瘤患者：该女性患者初始分期为IVA期，存在膈上淋巴结及骨骼受累。经6个周期ABVD方案（多柔比星、博来霉素、长春碱、达卡巴嗪）治疗后，正电子发射计算机断层显像（positron emission tomography, PET）显示淋巴结病灶完全代谢缓解，但骨骼病灶仍呈持续性高代谢活性。随后患者接受挽救治疗并行自体干细胞移植，移植后PET复查仍显示骨骼病灶维持高代谢活性。经靶向骨活检后，确诊为骨纤维异常增殖症，排除霍奇金淋巴瘤累及。据我们所知，此前尚未见霍奇金淋巴瘤与骨纤维异常增殖症合并存在的报道。对PET高摄取骨骼病灶行活检以评估一线治疗疗效，本可避免该患者接受过度治疗。