CASE 95

By: Dr. Aliya Sarhan Al Barwani

HISTORY: 43-year-old male with right shoulder pain 2 months back.

What are the findings?

List three differential diagnosis?

What is the prognosis of this case?

FINDINGS:

Plain Radiograph of the right humerus AP view: Ill define destructive lytic lesion in the humeral head with permeative appearance and wide zone of transition in the metadiaphysis of the right proximal humerus. No periosteal reaction nor cortical destruction. There are no extra-osseous soft tissue components.

MRI axial T2WI the corresponding lesion is high in signal in T2WI with very small extra-osseus soft tissue components. It is low in signal on T1WI. It has permeative appearance and wide zone of transition extending to proximal diaphysis.  

DIFFERENTIAL DIAGNOSIS:

·        Metastasis.

·        Lymphoma.

·        Multiple myeloma.

DIAGNOSIS:

Primary bone Lymphoma.

The Prognosis:  Better prognosis than other bony lesions. They show good respond to treatment (Chemotheray and Radiotherapy).

PEARLS AND DISCUSSION:

Primary bony lymphoma is rare tumor that is usually present as ill define permeative lesion with circumferential soft tissue components and surprisingly little cortical destruction. The vast majority of primary lymphoma are non-Hodgkin lymphoma.

These tumors have better prognosis compared to other primary bony lesions. They show good response to chemotherapy and radiotherapy with a 5-year survival rate reaching 83%. MRI and PET CT are the best modalities for follow up the response to treatment.

FURTHER READING:

1.      Krishnan A, Shirkhoda A. Primary bone lymphoma: radiographic-MR imaging correlation. Radiographics. (2003)

2.      Heyning FH, Kroon HM. MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skeletal Radiol. (2007)

3.      Chee Yeong Lim and Keh Oon Ong. Imaging of musculoskeletal lymphoma. Cancer Imaging. (2013)

4.      Hwang S. Imaging of lymphoma of the musculoskeletal system. Radiol Clin North Am. (2008)