Age / Sex : 76 / M

Chief complaint : Coccygeal pain, Fever


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 : 류혜진 (Yoo Hyejin), 서울대학교병원 (Seoul National University Hospital)

ALK-negative anaplastic large cell lymphoma

Discussion

Findings
1. Diffuse bone marrow signal alteration with heterogeneous enhancement at S1-2
2. Prevertebral and anterior epidural soft tissue mass with homogeneous enhancement
3. Subtle osteosclerotic change on CT

Discussion
1. Extranodal and spinal, epidural presentation of malignant lymphoma is rare. The rate of epidural occurrence in all case of malignant lymphomas is rare (0.8 - 2.8%).
2. MRI appearance was isointense on T1-weighted images and iso- to hyperintense on T2-weighted images, with marked contrast enhancement. The signal was homogeneous in all the sequences.

References
1. Epidural malignant lymphomas of the spine: collected experiences with epidural malignant lymphomas of the spinal canal and their treatment. Spinal Cord volume 46, pages278–281 (2008)
2. Primary spinal epidural lymphomas. 2011 Jan-Jun;2(1):3–11. doi: 10.4103/0974-8237.85307