ABSTRACT
A 35-year-old man presented with insidious onset of severe sacral pain. Plain radiography, computed tomography, and magnetic resonance imaging revealed a large, locally invasive mass within the sacrum. Skeletal scintigraphy showed marked hyperemia and minimal peripheral osteoblastic activity of the sacral mass. An F-18 FDG PET study was performed for further assessment and clinical staging. The mass demonstrated high glucose avidity consistent with a high-grade tumor. Histologic examination confirmed the lesion to be a plasmacytoma. Solitary plasmacytoma of bone occurs predominantly in older patients involving the axial skeleton. This case is interesting in view of the large dimension, sacral involvement, the young age of the patient, and the appearance of this lesion across multiple imaging modalities.
Subject(s)
Arthralgia/diagnostic imaging , Arthralgia/etiology , Bone Neoplasms/diagnostic imaging , Low Back Pain/etiology , Plasmacytoma/diagnostic imaging , Sacroiliac Joint/diagnostic imaging , Sacrum/diagnostic imaging , Adult , Bone Neoplasms/complications , Humans , Male , Plasmacytoma/complications , Radionuclide Imaging , Rare Diseases/complications , Rare Diseases/diagnostic imaging , Severity of Illness IndexABSTRACT
Primary or secondary lymphoma of the bone is uncommon. The sites of bony involvement include, in decreasing order of frequency, the spine, long bones, pelvis, ribs, and skull. A 66-year-old man with an atypical lineage of B-cell non-Hodgkin lymphoma is presented. The unusual initial presentation of the lymphoma included symmetric bony involvement of bilateral tibiae and the distal right femur, demonstrated on gallium-67 scintigraphy. The patient subsequently demonstrated resolution of the gallium-avid disease after treatment with fludarabine, cyclosporine, and ATG. This case also demonstrates the limitations of plain radiograph and the usefulness of MRI in the diagnosis of bony lymphoma.
