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Vol 70, No 6 (2020)
Case report
Published online: 2020-12-04
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Histiocytic lymphadenopathy secondary to metallosis following endoprosthetic replacement in osteosarcoma patient – a potential diagnostic pitfall

Kamil Sokół12, Bartłomiej Szostakowski3, Maria Chraszczewska12, Tomasz Goryń3, Michał Wągrodzki1, Monika Prochorec-Sobieszek12, Anna Szumera-Ciećkiewicz12
DOI: 10.5603/NJO.2020.0053
·
Nowotwory. Journal of Oncology 2020;70(6):272-275.
Affiliations
  1. Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
  2. Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
  3. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

open access

Vol 70, No 6 (2020)
Case report
Published online: 2020-12-04

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.

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.

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Keywords

metallosis; osteosarcoma; lymphadenopathy; endoprosthesis; metal on metal

About this article
Title

Histiocytic lymphadenopathy secondary to metallosis following endoprosthetic replacement in osteosarcoma patient – a potential diagnostic pitfall

Journal

Nowotwory. Journal of Oncology

Issue

Vol 70, No 6 (2020)

Article type

Case report

Pages

272-275

Published online

2020-12-04

Page views

484

Article views/downloads

978

DOI

10.5603/NJO.2020.0053

Bibliographic record

Nowotwory. Journal of Oncology 2020;70(6):272-275.

Keywords

metallosis
osteosarcoma
lymphadenopathy
endoprosthesis
metal on metal

Authors

Kamil Sokół
Bartłomiej Szostakowski
Maria Chraszczewska
Tomasz Goryń
Michał Wągrodzki
Monika Prochorec-Sobieszek
Anna Szumera-Ciećkiewicz

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