Secondary bone lymphoma

Case contributed by Amr Farouk
Diagnosis certain


Known patient with non-Hodgkin lymphoma 9 months ago on chemotherapy presenting with bony aches and severe back pain.

Patient Data

Age: 35 years

Innumerable scattered variable sized osseous lesions are seen involving almost all of the examined vertebrae, sternal body and pelvic bones, the largest osseous lesion is seen at the left iliac bone measuring 4.5 x 1.9 cm along its maximal axial dimensions. They are seen eliciting low T1, intermediate to high signal on T2 WI and high signal on STIR WIs.

Marked structural collapse of L5 vertebra showing abnormal marrow infiltration appearing of low T1 and high T2 signal. Mild backward bulge of the collapsed vertebra indenting the thecal sac with no associated soft tissue components seen.

Case Discussion

The patient is diagnosed with Non-Hodgkin-Lymphoma (NHL) with secondary bone involvement confirmed by bone marrow aspirate and biopsy.

Secondary bone lymphoma is lymphoma involving the bone with nodal disease occurring within six months or secondary lymphoma involving the bone at least six months after diagnosis. Secondary bone involvement can result from direct spread from nodal disease or hematogenous metastases. The axial skeleton is more often affected than the appendicular skeleton with the most frequent location is the spine.

Osseous involvement varies from lytic lesions, permeative bone destruction with cortical breach ± adjacent soft tissue mass.

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