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Lymphoma of the spine

Case contributed by: Dr Frank Gaillard

Presentation:

Elderly patient presenting with fecal incontinence.

Patient Data:

Age: Elderly adult

CT lumbar spine

Modality: CT

CT demonstrates slight sclerosis of the body of L5 with soft tissue density appearing to fill the canal. 

MRI lumbar spine (with contrast)

Modality: MRI

MRI confirms the abnormality, and demonstrates complete replacement of normal bone marrow signal with the entire L5 vertebral body (including posterior elements) with soft tissue compressing the cauda equina. 

Case Discussion:

Histology

Microscopic description

Sections show multiple small cores of highly cellular tumour with a significant degree of crush artefact. The cells appear to be a mixture of atypical cells with large pleomorphic nuclei as well as some chronic inflammatory cells. No specific architectural pattern is identified. Immunohistochemistry shows the majority of cells to express the B-cell marker CD20, while CD3 identifies a lesser population of small reactive appearing T lymphocytes. There is no staining for cytokeratin or S100 protein. The quality of the immunostaining for kappa and lambda light chains is poor however there is no obvious difference in the degree of positivity. MIB-1 demonstrates very high proliferative activity. Immunohistochemistry for the plasma cell marker CD138 is negative.

Final diagnosis

High-grade B cell lymphoma.

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