Lymphoma of the spine

Case contributed by A.Prof Frank Gaillard

Presentation

Back pain.

Patient Data

Age: 50 years
Gender: Male
MRI

MRI lumbar spine

MRI demonstrates a pathological crush fracture of L4 with complete replacement of the normal fatty marrow with low T1 signal soft tissue which enhances following administration of contrast. A moderate to severe degree of canal stenosis is present. Additional deposit is seen at T12. 

An old crush fracture (non-pathological) of L1 is also present with normal bone marrow signal. 

Case Discussion

This patient has had a previous liver transplant for biliray atresia,  splenectomy, and has been on tacrolimus since 1998. Never has has rejection issues. PET scan (not shown) demonstrated FDG avid lymph nodes above and below the diaphragm.

Appearances in the spine are consistent with lymphoma, although other metastatic disease could have similar appearances. 

Pathology

Histology of a cervical lymph node biopsy. 

The lymph node  is partially  effaced by an  atypical lymphoid  infiltrate, comprising large  cellular nodules separated  by thin bands  of hyalinized stroma. These nodules contain sheets  of large atypical lymphoid cells with rounded to irregular nuclei  and one to three large  eosinophilic nucleoli. The cells have minimal  pale eosinophilic cytoplasm.   Admixed lymphocytes, histiocytes and sparse plasma cells are noted. Eosinophils are not seen and discrete granulomas are  not identified. No  transgression beyond the lymph node capsule is found.

Immunohistochemical   studies  have  been  performed.   The large  atypical lymphoid  cells are  strongly positive  for  CD20,  Pax-5, CD45,  CD30 and EBER-ISH. They are negative  for EMA, ALK, CD15, CD79a, and Cyclin D1. The Ki-67 proliferative index in the large cells is approximately 95%.

The admixed small lymphocytes  are reactive T cells  (CD3 and CD5 positive) and there are  a few admixed macrophages  showing  paranuclear  dot - like  pattern of staining for CD15. The atypical lymphoid population is CD10 negative, bcl-6 positive, and MUM1 positive.

 DIAGNOSIS: Right cervical lymph node - monomorphic post transplant lymphoproliferative disorder,   diffuse  large  B  cell  lymphoma   type,  with  partial  nodal involvement.

PlayAdd to Share

Case information

rID: 14396
Case created: 21st Jul 2011
Last edited: 13th Nov 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.