Author Block: V. Di Martino, N. Di Meglio, A. Perrella, G. Bagnacci, C. Sica, M. A. Mazzei; Siena, SI/IT
Purpose: We report six cases of bone lymphoma presenting with lower back pain which occurred over a two year period, from 2020 to 2022, in our centre. This study highlights relevant imaging features with a special focus on MR.
Methods or Background: Bone lymphoma presenting with musculoskeletal pain is an often challenging diagnosis because its imaging features are nonspecific. It is classified either as primary bone lymphoma (PBL, no other extraosseous site involved), or secondary bone involvement in systemic lymphoma (SBL, secondary bone lymphoma). SBLs are much more frequent (30-50% of all non-Hodgkin Lymphomas, NHLs, and 5- 10% of all Hodgkin Lymphomas, HLs), while primary bone lymphomas are rare (<5% of primary bone tumours and 1% of all NHLs, more often a form of diffuse large B cell lymphoma, DLBCL).
Results or Findings: Four females and two males (aged 21 to 80 years) with persistent lower back pain underwent an MRI and subsequently a body contrast-enhanced CT and/or a PET/CT. The diagnosis was confirmed with a biopsy: four PMLs (DLBCL), two SBLs (one HL and one NHL). In all cases bone lesions were characterised by marked signal hypointensity on T1-weighted MRI corresponding to heterogeneous hyperintensity on T2-weighted images, asymmetric, not confined to the subchondral bone and, in two cases, also associated with soft tissue involvement but without significant cortical bone destruction. In four cases bone lesions were visible at CT with a permeative or lytic pattern. Both cases of SBL presented systemic symptoms as well (fever and night sweats).
Conclusion: Bone lymphoma should always be considered in the differential diagnosis of patients presenting with lower back pain, especially if the imaging features of bone lesions are atypical or associated with fever, night sweats, and weight loss.
Limitations: This study is limited by its case series methodology.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.