Presentation
Severe back pain at the lower dorsal region.
Patient Data
The MRI sequences demonstrate a lobulated left paraspinal mass at T9-T11 level, measuring 63 x 48 x 35 mm extending into the spinal canal through the T9-T10 and T10-T11 foramina, compressing the adjacent segment of the spinal cord which is displaced to the right. It displays a low signal on T1, high signal on T2 and STIR with a heterogeneous enhancement on postcontrast sequences.
Another paravertebral soft tissue mass of retroperitoneal location is seen at T12 level of similar signal and enhancement measuring 38 x 30 x 13 mm, invading the diaphragm and most likely the upper pole of the left kidney.
Moderate splenomegaly (15 cm).
Case Discussion
MRI features of left paraspinal masses with two components: the upper component is located at T9-T11 level and shows an intraspinal extension through the adjacent T9-T10 and T10-T11 foramina, and that located at T12 level shows invasion of the left hemidiaphragm and most likely the upper pole of the left kidney.
A CT-guided paraspinal biopsy was performed with histopathological exam and immunohistochemistry study which confirm the diagnosis of a diffuse large B cell lymphoma.
The main differential diagnoses in such location with intraspinal extension are neurogenic tumors.
Additional contributor: ZE. Boudiaf MD CHU, Constantine Algeria