Vol 70, No 6 (2020)
Case report
Published online: 2020-12-04
Histiocytic lymphadenopathy secondary to metallosis following endoprosthetic replacement in osteosarcoma patient – a potential diagnostic pitfall
12, 3, 12, 3, 1, 12, 12
Nowotwory. Journal of Oncology 2020;70(6):272-275.
Abstract
We present the case of a 43-year old patient with inguinal lymphadenopathy 22 years after distal femoral resection for osteosarcoma with cemented distal femoral replacement reconstruction. Seven years after initial distal femoral resection patient underwent metal on metal hip resurfacing arthroplasty on the affected side. Twenty years after distal femoral replacement and 13 years after metal on metal hip resurfacing procedure, the patient underwent left inguinal lymphadenectomy for an enlarged mass of inguinal lymph nodes on suspicion for a sarcoma recurrence. On microscopic examination, excised lymph nodes were massively infiltrated with macrophages and multinucleated giant cells with focal asteroid bodies. An examination in polarized light revealed numerous metal particles; immunohistochemical stainings confirmed reactive character of changes, and florid metal-related sinus histiocytosis was finally diagnosed. Microscopic assessment of lymph nodes in the course of malignancy is a standard procedure; we present a rare case of non-neoplastic lymph node enlargement due to the late onset of metallosis, which might be a diagnostic challenge.
Keywords: metallosisosteosarcomalymphadenopathyendoprosthesismetal on metal
References
- Willard-Mack CL. Normal structure, function, and histology of lymph nodes. Toxicol Pathol. 2006; 34(5): 409–424.
- Stewart AJ, Southcott BM, Raweily E. Lymphadenopathy after joint replacement for osteoclastoma. J R Soc Med. 2003; 96(8): 404–406.
- Calo C, Preston H, Clements A. Retroperitoneal lymphadenopathy secondary to joint replacement wear and debris, a case report. Gynecol Oncol Rep. 2018; 23: 10–12.
- Wojciechowska U, Didkowska J, Olasek P. Nowotwory złośliwe w Polsce w 2015 roku - Cancer in Poland in 2015. Krajowy Rejestr NowotworówZakład Epidemiologii i Prewencji Nowotworów, Warszawa 2017.
- Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res. 2009; 152: 3–13.
- Czerniak B. Dorfman and Czerniak's Bone Tumors, 2nd ed. Elsevier 2015.
- Dorfman HD, Czerniak B. Bone cancers. Cancer. 1995; 75(1 Suppl): 203–210, doi: 10.1002/1097-0142(19950101)75:1+<203::aid-cncr2820751308>3.0.co;2-v.
- Fletcher C, Bridge J, Hogendoorn P, Mertens F. WHO Classification of Tumours of Soft Tissue and Bone, 4th ed. IARC, Lyon 2013.
- Durfee RA, Mohammed M, Luu HH. Review of Osteosarcoma and Current Management. Rheumatol Ther. 2016; 3(2): 221–243.
- Klein MJ, Siegal GP. Osteosarcoma: anatomic and histologic variants. Am J Clin Pathol. 2006; 125(4): 555–581.
- Dirik Y, Çınar A, Yumrukçal F, et al. Popliteal lymph node metastasis of tibial osteoblastic osteosarcoma. Int J Surg Case Rep. 2014; 5(11): 840–844.
- Thampi S, Matthay KK, Goldsby R, et al. Adverse impact of regional lymph node involvement in osteosarcoma. Eur J Cancer. 2013; 49(16): 3471–3476.
- Whelan JS, Bielack SS, Marina N, et al. EURAMOS collaborators. EURAMOS-1, an international randomised study for osteosarcoma: results from pre-randomisation treatment. Ann Oncol. 2015; 26(2): 407–414.
- Hwang JS, Mehta AD, Yoon RS, et al. From amputation to limb salvage reconstruction: evolution and role of the endoprosthesis in musculoskeletal oncology. J Orthop Traumatol. 2014; 15(2): 81–86.
- Isakoff MS, Bielack SS, Meltzer P, et al. Osteosarcoma: Current Treatment and a Collaborative Pathway to Success. J Clin Oncol. 2015; 33(27): 3029–3035.
- Rakow A, Schoon J, Dienelt A, et al. Influence of particulate and dissociated metal-on-metal hip endoprosthesis wear on mesenchymal stromal cells in vivo and in vitro. Biomaterials. 2016; 98: 31–40.
- Oliveira CA, Candelária IS, Oliveira PB, et al. Metallosis: A diagnosis not only in patients with metal-on-metal prostheses. Eur J Radiol Open. 2015; 2: 3–6.
- Natu S, Sidaginamale RP, Gandhi J, et al. Adverse reactions to metal debris: histopathological features of periprosthetic soft tissue reactions seen in association with failed metal on metal hip arthroplasties. J Clin Pathol. 2012; 65(5): 409–418.
- Bitar D, Parvizi J. Biological response to prosthetic debris. World J Orthop. 2015; 6(2): 172–189.
- Benz EB, Sherburne B, Hayek JE, et al. Lymphadenopathy associated with total joint prostheses. A report of two cases and a review of the literature. J Bone Joint Surg Am. 1996; 78(4): 588–593.
- Khan WS, Agarwal M, Malik AA, et al. Chromium, cobalt and titanium metallosis involving a Nottingham shoulder replacement. J Bone Joint Surg Br. 2008; 90(4): 502–505.
- Davies AM, Cooper SA, Mangham DC, et al. Metal-containing lymph nodes following prosthetic replacement of osseous malignancy: potential role of MR imaging in characterisation. Eur Radiol. 2001; 11(5): 841–844.
- Baslé MF, Bertrand G, Guyetant S, et al. Migration of metal and polyethylene particles from articular prostheses may generate lymphadenopathy with histiocytosis. J Biomed Mater Res. 1996; 30(2): 157–163, doi: 10.1002/(SICI)1097-4636(199602)30:2<157::AID-JBM4>3.0.CO;2-Q.
- Ma Y, Gal A, Koss M, et al. The pathology of pulmonary sarcoidosis: update. Semin Diagn Pathol. 2007; 24(3): 150–161.
- Malzone MG, Campanile AC, Gioioso A, et al. Silicone lymphadenopathy: presentation of a further case containing asteroid bodies on fine-needle cytology sample. Diagn Cytopathol. 2015; 43(1): 57–59.
- van Diest PJ, Beekman WH, Hage JJ. Pathology of silicone leakage from breast implants. J Clin Pathol. 1998; 51(7): 493–497.
- Gouvêa AF, Hanemann JA, Pereira AA, et al. Uncommon foreign body reactions occurring in the lip: clinical misdiagnosis and the use of special techniques of analysis. Head Neck Pathol. 2011; 5(1): 86–91.
- Guarner J, Brandt ME. Histopathologic diagnosis of fungal infections in the 21st century. Clin Microbiol Rev. 2011; 24(2): 247–280.
- Patil S, Rao RS, Amrutha N. A Spider like body in Keratocystic Odontogenic Tumor - A Paradoxical find. J Int Oral Health. 2013; 5(6): 131–133.
- Anderson JM, Rodriguez A, Chang DT. Foreign body reaction to biomaterials. Semin Immunol. 2008; 20(2): 86–100.
- Rodríguez G, Sarmiento L. The asteroid bodies of sporotrichosis. Am J Dermatopathol. 1998; 20(3): 246–249.
- Ollivere B, Darrah C, Barker T, et al. Early clinical failure of the Birmingham metal-on-metal hip resurfacing is associated with metallosis and soft-tissue necrosis. J Bone Joint Surg Br. 2009; 91(8): 1025–1030.
- Shinto Y, Uchida A, Yoshikawa H, et al. Inguinal lymphadenopathy due to metal release from a prosthesis. A case report. J Bone Joint Surg Br. 1993; 75(2): 266–269.