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DIFFUSE LARGE B CELL LYMPHOMA
Authored By: O'Neil Lee and Henry Royal.
Patient: 64 year old male
History: 6 weeks of severe left lower leg pain
Image Size:[small][as-submitted]

Fig. 1
Delayed whole body

Fig. 2
Angiographic and blood pool images

Fig. 3
Delayed left and right lateral knees

Fig. 4
Left knee AP

Fig. 5
Left knee lateral

Fig. 6
Axial T1 post-gadolinium
Image Size:[small][as-submitted]

Findings: Increased radiotracer uptake on all 3 phases of bone scan within the left proximal tibia. The scintigraphic appearance of the proximal tibia is suggestive of Paget's disease, though osteomyelitis and neoplasm could have a similar apperance.  Radiographs of the proximal tibia show a non-specific lytic lesion.  Classic radiographic findings of cortical thickening and coarse trabeculation are not seen.  MRI shows abnormal bone marrow signal within the proximal tibia with an associated surrounding soft tissue mass.  Abnormal enhancement is seen both in the bone marrow and the soft tissue mass.
DDx: Paget's disease, osteomyelitis, neoplasm (primary bone tumor, metastasis, lymphoma)
Diagnosis: Diffuse large B cell lymphoma (biopsy-proven)
General Discussion: Scintigraphic appearance of the lesion within the proximal tibia is highly suggestive of Paget's disease.  However, osteomyelitis was a leading consideration based on the radiographic appearance.  MRI showed abnormal signal within the bone marrow as well as a surrounding soft tissue mass, concerning for neoplasm.  Subsequent bone marrow biopsy revealed a diagnosis of lymphoma.  This is a rare case of a neoplasm mimicking Paget's disease on bone scintigraphy.
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Additional Details:

Case Number: 104352Owner(s): O'Neil Lee and Henry RoyalLast Updated: 02-07-2013
Anatomy: Skeletal System   Pathology: Neoplasm
Modality: Conventional Radiograph, MR, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: lymphoma, bsnmACR: 40000.34000

Case has been viewed 23 times.
Certified by Henry Royal on 09-17-2009

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