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

Kyung Ryeol Lee; Young Hee Maeng

doi:10.13104/imri.2019.23.3.270

Journal List > Investig Magn Reson Imaging > v.23(3) > 1135557

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Lee and Maeng: 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

Original Article

iMRI 2019;23(3):270-275.

Published online: 12 January 2019

DOI: https://doi.org/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

Kyung Ryeol Lee, Young Hee Maeng

^¹Department of Radiology, Jeju National University Hospital, Jeju-si, Korea

^²Department of Pathology, Jeju National University Hospital, Jeju-si, Korea

Correspondence to: Kyung Ryeol Lee, M.D. Department of Radiology, Jeju National University Hospital, 15 Aran 13-gil, Jeju-si, Jeju-do 63241, Korea. Tel. +82-64-717-1373 Fax. +82-64-717-1377 E-mail: we1977@naver.com

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.

Received 20 May 2019 Revised 4 July 2019 Accepted 29 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study presents a case of diffuse large B cell lymphoma (DLBCL) in a 58-yearold 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.

Keywords: Bone, Lymphoma, Osteomyelitis, Diffusion weighted magnetic resonance imaging

References

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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.

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).

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).

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.

Fig. 6.

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

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