Multifocal large B-cell bone lymphoma

Case contributed by Dr Abeer Ahmed Alhelali

Presentation

Presented with a 5-month history of pain in the right lower limbs with night sweating and weight loss of 20 kilograms.

Patient Data

Age: 65 years
Gender: Male

Juxta-articular osteopaenia involving tarsals, metatarsals and phalanges.

Multifocal areas of bone resorption involving multiple tarsals, metatarsals, phalanges as well as distal end of tibia and fibula.

Coronal view shows multifocal areas of predominantly well-defined abnormal marrow signal appearing hypointense on T1WI.

On the axial images there are multifocal areas of predominantly well-defined hyperintense signal on STIR. Subtle enhancement of a few of the bony lesions and area of extra-osseous soft tissue component (arrow) on post contrast T1 fat saturated image.

Pathology

CT-guided biopsy reveal diffuse large B-cell lymphoma.

Patchy dense tumour infiltrates with severe crushing artefact of the marrow. Morphological details are lost. The diagnosis of B cell lymphoma is based on strong CD20 and CD45 staining of a dense crushed lymphoid infiltrate.

Thanks to Dr. Lois Richard. Consultant Hematopathology (Sheikh Khalifa Medical City, Abu Dhabi, UAE)

Case Discussion

The radiological appearance of bone lymphoma is variable and nonspecific, varying from focal lytic lesions with geographic margins to mixed sclerotic/lytic lesions or diffuse permeative processes.

Special thanks to Dr. Mohamed Ashfaque Kukkady.

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Case information

rID: 51238
Case created: 7th Feb 2017
Last edited: 8th Feb 2017
Inclusion in quiz mode: Included

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