Age / Sex : 89 / M

Chief complaint : Right lower leg pain

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 김완태 (Wan Tae Kim), 중앙보훈병원 (Veterans Health Service Medical Center)

Primary lymphoma of bone (Diffuse large B-cell lymphoma)

Discussion

Findings

- Plain radiograph

  : Tibia AP view shows well defined osteolytic lesion and focal permeative change in distal diaphysis of right tibia.

- MR findings

• T1-weighted image shows intermediate signal intensity intramedullary lesion with minimal cortical erosion of right tibia.


• T2-weighted image shows heterogenous high signal intensity intraosseous mass lesion and soft tissue infiltration.


• Contrast enhanced T1-weighted image demonstrates heterogenous enhancement of intraosseous and soft tissue mass.

1. Metastasis


2. Osteomyelitis


3. Osteosarcoma

1.Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol. 1999 Dec;173(6):1691-1697.

2.Krishnan A, Shirkhoda A, Tehranzadeh J, Armin AR, Irwin R, Les K. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics. 2003 Nov-Dec;23(6):1371-1383.

3.Heyning FH, Kroon HM, Hogendoorn PC, Taminiau AH, van der Woude HJ. MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skeletal Radiol. 2007 Oct;36(10):937-944.