Introduction: Primary Non Hodgkin Lymphoma (NHL) of the bone is rare malignancy accounting less than 1–2% of adult NHL and less than 7–10% of primary bone tumors. Most primary bone lymphomas are NHL with diffuse large B-cell subtype. It is frequently misdiagnosed due to its rarity, uncommon presentation and indistinctive radiographic features.

Case Report: A 40-year-old man presented with the left 2nd metacarpal tumor complained of pain, swelling with difficulty in both active and passive movements. The diagnosis of bone NHL established from clinical finding, radiographic examination and biopsy. Immunohistochemical result showed positivity of LCA and CD20, with high proliferation index of Ki-67, suggesting B-cell lineage of lymphoma. Functional hand reconstruction with modified pollicization technique and posterior interosseous artery flap were performed. The follow-up for the possibility of a local tumour recurrence and metastasis was evaluated after 8 courses of RCHOP regiment chemotherapy.

Conclusion: Primary NHL of the bone especially in hand is very rare and challenging condition for orthopaedic surgeons. The triple diagnosis of clinical, radiographic and biopsy examinations were very useful to establish solid diagnosis of bone NHL. Therefore, prognosis, nonetheless, is much better than that of other malignant bone tumours. Awareness and knowledge in decision making of hand reconstruction and post-operative chemotherapy planning are needed to achieve statisfactory outcome.

Keywords: Hand reconstruction, NHL of the bone, Pollicization technique, Primary bone lymphoma