Primary lymphoma of bone

Case contributed by Dr Valerio Giacalone

Presentation

Large, very painful swelling of the anterior region of the femur. The patient has been reporting progressive pain and swelling for about 4 months.

Patient Data

Age: 50 years old
Gender: Female
x_ray

Osteolytic lesion with alteration of the cortical profile of the femur and radiopaque thickening of the adjacent muscle tissues.

mri

An intramedullary mass is detected in the femur causing cortical destruction.

A large mass of soft tissue surrounds the femur, a finding that is consistently found in round cell tumors.

The mass shows an intermediate T1 signal, slightly higher than the muscle. Medium to low signal in T2 sequences and high signal in STIR images and fat suppressed images. Contrast enhancement is seen intravenously based on gadolinium injection of contrast medium.

ct

The CT scan shows an osteolytic lesion mid-shaft lesion of the femur. Appreciable interruption of the cortical bone and the amount of adjacent tissue.

Case Discussion

Suspected primary bone lymphoma.

An osteolytic lesion with patterns of permeation or 'moth eaten' destruction, located in the femur diaphysis, is appreciated. This lesion appears aggressive and is characterized by periosteal reaction, cortical destruction and neoplastic soft tissue infiltration.

MRI detects a hypointense injury to the muscle on T1-weighted and hyperintense images on T2-weighted or fluid sensitive image sequences and shows improvement after injection. application of gadolinium-based contrast agents. The extent of soft tissue involvement is easily assessed by magnetic resonance imaging.

At CT, an appreciable osteolytic lesion with small breaks in the bone cortical. The diagnostic picture is indicative of primary bone lymphoma. 

The mass was biopsied and histopathology demonstrated lymphoma.

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