End Plate Disproportion and Degenerative Disc Disease: A Case-Control Study

STUDY DESIGN: Case-control. PURPOSE: To determine whether a disproportion between two neighboring vertebral end plates is associated with degenerative disc disease. OVERVIEW OF LITERATURE: Recently, it has been suggested that disproportion of the end plates of two adjacent vertebrae may increase the risk of disc herniation. METHODS: Magnetic resonance (MR) images (n=160) with evidence of grades I-II lumbar degenerative disc disease (modified Pfirrmann's classification) and normal MR images of the lumbar region (n=160) were reviewed. On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a degenerated (in the case group) or normal (in the control group) intervertebral disc was calculated (difference of end plates [DEP]). RESULTS: Mean DEP was significantly higher in the case group at the L5-S1 level (2.73+/-0.23 mm vs. 2.21+/-0.12 mm, p=0.03). Differences were not statistically significant at L1-L2 (1.31+/-0.13 mm in the cases vs. 1.28+/-0.08 mm in the controls, p=0.78), L2-L3 (1.45+/-0.12 mm in the cases vs. 1.37+/-0.08 mm in the controls, p=0.58), L3-L4 (1.52+/-0.13 mm in the cases vs. 1.49+/-0.10 mm in the controls, p=0.88), and L4-L5 (2.15+/-0.21 mm in the cases vs. 2.04+/-0.20 mm in the controls, p=0.31) levels. The difference at the L5-S1 level did not remain significant after adjusting for body mass index (BMI), which was significantly higher in the patients. CONCLUSIONS: End plate disproportion may be a significant, BMI-dependent risk factor for lumbar degenerative disc disease.

Bilateral primary breast lymphoma in a teenage girl with multi-organ involvement

We present 16 years old girl with primary breast lymphoma involving the both breasts simultaneously and co-incidence of central nervous system [CNS] involvement which originated from the breast, in addition to evidence of lymphoma in multi-organ such as skin, mediastinum and some abdominal viscera. Bilaterality has been observed in some series, but reports are few and series are often very small. Radiologic features may be indistinguishable from those of the other breast malignancies, but it can be concluded that primary involvement of the breast with lymphoma should be considered when breast mass or inflammatory changes occur in a patient without any previously diagnosed lymphoma. The clinical behavior, imaging and therapeutic procedures are discussed. The findings of this report may have clinical impact on oncologists or that may alter the disease concept of bilateral breast lymphoma.