Lymphoma of the spine

Case contributed by Frank Gaillard
Diagnosis certain


Elderly patient presenting with fecal incontinence.

Patient Data

Age: Elderly adult

CT lumbar spine


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

MRI Lx spine C+


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

The patient went on to have a biopsy.


Sections show multiple small cores of highly cellular tumor 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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