Investig Magn Reson Imaging.  2019 Sep;23(3):270-275. 10.13104/imri.2019.23.3.270.

Bone Involvement of Diffuse Large B Cell Lymphoma (DLBCL) Showing Unusual Manifestations Mimicking Chronic Osteomyelitis in a 58-Year-Old Man: Case Report and Clinical Application of Diffusion Weighted Magnetic Resonance Imaging

• Lee KR
• Maeng YH

• KMID: 2459882
• DOI: http://doi.org/10.13104/imri.2019.23.3.270

Abstract

This study presents a case of diffuse large B cell lymphoma (DLBCL) in a 58-year-old man showing unusual manifestations mimicking chronic osteomyelitis. In this case review, we describe the imaging findings of DLBCL which mimics chronic osteomyelitis and review existing reports regarding the differential diagnosis of bone involvement of lymphoma and osteomyelitis through imaging and laboratory findings and diffusion-weighted magnetic resonance imaging (DWI) such as the advanced MRI sequence.

Keyword

Bone; Lymphoma; Osteomyelitis; Diffusion weighted magnetic resonance imaging

MeSH Terms

Diagnosis, Differential
Diffusion*
Humans
Lymphoma
Lymphoma, B-Cell*
Magnetic Resonance Imaging*
Middle Aged*
Osteomyelitis*

Figure

• 

  Fig. 1. AP (a) and lateral (b) radiographs of the left knee shows an osteolytic lesion with moth-eaten bone destruction in the distal diaphysis of the left femur. The lateral view of the left knee shows suspected sequestrum (white arrow) in the lesion and a single layer of periosteal new bone formation (yellow arrow) adjacent to the lesion.

• 

  Fig. 2. Sagittal T2-weighted MR image (a) shows cortical perforation suggesting cloaca (yellow arrow) and suspected bony sequestrum (white arrow) in the distal diaphysis of the left femur. On coronal T1-weighted MR image (b), the lesion of the left distal femur shows low signal intensity and on coronal contrast-enhanced fat-suppressed T1-weighted MR image (c), the lesion consisting of non-enhancing portion that has suspected necrosis and enhancing portion in the periphery of the lesion.

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  Fig. 3. Axial T2-weighted MR image (a) shows cortical perforation suggesting cloaca (yellow arrow) and axial contrast-enhanced fat-suppressed T1-weighted MR image (b) demonstrates the drainage of necrotic material out of the bone (black arrow).

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  Fig. 4. The measurement of ADC value at b 800 s/mm2 using axial contrast-enhanced fat-suppressed T1-weighted MR images, diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) map. (a) The mean ADC value of 0.84 × 10-3 mm2/s (b = 800 s/mm2) was found in the enhancing portion of the lesion (yellow arrow, yellow region of interest). (b) The mean ADC value was 1.87 × 10-3 mm2/s (b = 800 s/mm2) for the non-enhancing portion of the lesion (white arrow, white region of interest).

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  Fig. 5. Photomicrograph (a, Hematoxylin & Eosin [H&E], × 40) showing curetted tumor tissue admixed with bony trabeculae (arrows) and photomicrograph (b, H&E, × 40) showing necrotic areas (arrowheads). Photomicrograph (c, H&E, × 400) demonstrates neoplastic large lymphocytes and photomicrograph (d, × 200) illustrate that they are positive for CD20.

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  Fig. 6. PET CT demonstrates increased uptake in the left distal femur and lymph nodes of left inguinal, femoral, iliac, and paraaortic areas.

Reference

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