Investig Magn Reson Imaging.  2018 Mar;22(1):50-55. 10.13104/imri.2018.22.1.50.

Gelatinous Transformation of Bone Marrow Mimicking Malignant Marrow-Replacing Lesion on Magnetic Resonance Imaging in a Patient without Underlying Devastating Disease

• Lee J
• Yoo YH
• Lee S
• Kim HS
• Kim S

• KMID: 2408817
• DOI: http://doi.org/10.13104/imri.2018.22.1.50

Abstract

Gelatinous transformation of bone marrow is characterized by hypoplasia of fat cells with focal loss of hematopoietic cells and deposition of extracellular gelatinous substances. It is known to be associated with devastating underlying diseases that starve bone marrow. Here, we present a case of a patient whose magnetic resonance (MR) imaging findings of vertebral column were interpreted as metastasis or hematologic malignancy, however, the final diagnosis revealed a gelatinous transformation of bone marrow. This is the first report of gelatinous transformation of bone marrow without evidence of underlying devastating disease.

Keyword

Gelatinous transformation; Bone marrow; Magnetic resonance imaging; Positron emission tomography

MeSH Terms

Adipocytes
Bone Marrow*
Diagnosis
Gelatin*
Hematologic Neoplasms
Humans
Magnetic Resonance Imaging*
Neoplasm Metastasis
Positron-Emission Tomography
Spine
Gelatin

Figure

• 

  Fig. 1 Simple radiographs and computed tomography (CT) images of the lumbar spine obtained from a 75-year-old female who developed gelatinous transformation of the bone marrow. (a, b) Anterior and lateral lumbar spine radiographs revealed kyphosis and scoliosis of the thoracic-lumbar spine, with a wedging deformity of the L1 vertebral body. (c) CT shows a burst fracture of the L1 vertebral body without obvious osteolytic lesion. Diffuse lack of fat tissue on CT in and around the muscle is also seen.

• 

  Fig. 2 Sagittal magnetic resonance (MR) imaging of the lumbar spine. (a) The spinal bone marrow shows extensive hypointense signal involving the entire vertebral column on a T1-weighted (repetition time [TR]: 450 ms, echo time [TE]: 9.8 ms) image. Diffuse hypointense signal intensity of retroperitoneal fat (arrowhead) and subcutaneous fat (arrow) on T1-weighted image is also seen. Extensive loss of fat in and around the muscles and in the subcutaneous layer at the back, suggests severe malnutrition. (b) T2-weighted MR (TR: 4192 ms, TE: 100 ms) image shows irregular and patchy hyperintense signals of vertebral marrow with respect to skeletal muscle. Hyperintense signal intensity of retroperitoneal fat (arrowhead) and subcutaneous fat (arrow) on T2-weighted image is also seen. (c) Sagittal fat-saturated T2-weighted (TR: 4580 ms, TE: 113 ms) images show hyperintense signals interspersed in L-spine, which indicates that the lesions are not fatty marrow.

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  Fig. 3 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) of the whole body. (a, b) 18F-FDG-PET-CT scan revealed no hypermetabolic foci to suggest primary malignancy or distant metastasis, associated with the compressed L1 vertebral body (arrow).

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  Fig. 4 A biopsy specimen of the bilateral posterior superior iliac crest shows bone marrow with gelatinous transformation. (a) Fat atrophy, hypoplasia of trilineage hematopoietic cells, and accumulation of amorphous extracellular material are seen (Hematoxylin & Eosin staining, × 200). (b) The extracellular gelatinous substance tested positive for Alcian blue stain (Alcian blue, × 100).

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