EURORAD ESR

Case 15015

Primary Spinal Epidural Lymphoma mimicking Lumbar Spinal Stenosis

Author(s)
Joao Carlos Costa*, Teresa Joana Costa*, Henrique Rodrigues*, Joao Oliveira*, Pedro Marques*, Daniela Condesso*, Tiago Couto*, Fortunato Vieira*, Zandira Isaac **, Afonso Ruano***, Paulo Montanha***.

*JCC Diagnostic Imaging, Radiology Department Hospital Particular de Viana do Castelo, Portugal; Email:gito.jcc@gmail.com.

**Radiology Department, Clinica Girassol, Luanda, Angola.

***Ortopedic Surgery Department, Hospital de Bragança, Portugal.
 
Patient
female, 60 year(s)
 
 
  • Figure 1
    lombar X ray

    No changes are detected

     
    Area of Interest: Spine; Imaging Technique: Digital radiography; Procedure: Screening; Special Focus: Lymphoma;
     
     
  • Figure 2
    Sagital MRI T1weighted images
     

    MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;
     
     
  • Figure 3
    MRI T2 fat suppression weighted image
     

    MRI T2 FS weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;

    Axial T2 FS weighted image: epidural soft tissue component produces a polygonal appearance of the dural sac, reflecting tethering by the meningovertebral ligament (Hoffmann), lateral and dorsal additional ligaments.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Lymphoma;
     
     
  • Figure 4
    MRI- Difusion Weighted Images
     

    MRI T2/DWI Fusion Sagittal Image: marked restriction, not only in the soft tissue component, but also on vertebral bodies marrow involved.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI T2/DWI Fusion Sagittal Image: marked restriction, not only in the soft tissue component, but also on vertebral bodies marrow involved.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI T2/DWI Fusion Axial Image: marked restriction on extravertebral soft tissue component surrounding the vertebrae without cortical disruption - wraparound sign.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Imaging sequences; Special Focus: Lymphoma;

    MRI T2/DWI Fusion Axial Image: marked restriction on extravertebral soft tissue component surrounding the vertebrae without cortical disruption - wraparound sign.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Imaging sequences; Special Focus: Lymphoma;
     
     
  • Figure 5
    CT-Fluoroscopy biopsy
     

    Puncture of the extra vertebral component, under CT-Fluoroscopy, for cytological study.

     
    Area of Interest: Interventional non-vascular; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    Paravertebral soft tissue percutaneous CT-Fluoroscopy biopsy.

     
    Area of Interest: Interventional non-vascular; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    CT-Fluoroscopy vertebral body biopsy. No bone abnormalities on the CT images are seen; biopsy was performed at the site with MRI signal changes.

     
    Area of Interest: Interventional non-vascular; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;
     
     
  • Figure 6
    CT-Fluoroscopy biopsy. Histopathology
     

    Bone fragment, with a diffuse towel of small centrocytes, in the medullary spaces.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    Prominent lymphoid infiltration of paravertebral soft tissue with nodular pattern.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    Bone fragment: lymphoid infiltrate composed by small centrocytes.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    Hight-power field of neoplastic follicle with solid aggregates of centroblasts.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    Immunohistochemical stain for CD20, highlights numerous B cells and the follicular pattern

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Metabolic disorders;

    Immunohistochemical stain for bcl-2, highlights the neoplastic follicles.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;

    Immunohistochemical stain for CD21 highlights follicular dendritic cell meshworks within neoplastic follicles

     
    Area of Interest: Neuroradiology spine; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Lymphoma;
     
     
No changes are detected
 
MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.
 
MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression
 
MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.
 
MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.
 
MRI sagittal T1 weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.
 
MRI T2 FS weighted image: low signal in L1, L3 and L4 vertebral bodies. Soft tissue masses in perivertebral and epidural spaces with severe cauda equina compression.
 
Axial T2 FS weighted image: epidural soft tissue component produces a polygonal appearance of the dural sac, reflecting tethering by the meningovertebral ligament (Hoffmann), lateral and dorsal additional ligaments.
 
MRI T2/DWI Fusion Sagittal Image: marked restriction, not only in the soft tissue component, but also on vertebral bodies marrow involved.
 
MRI T2/DWI Fusion Sagittal Image: marked restriction, not only in the soft tissue component, but also on vertebral bodies marrow involved.
 
MRI T2/DWI Fusion Axial Image: marked restriction on extravertebral soft tissue component surrounding the vertebrae without cortical disruption - wraparound sign.
 
MRI T2/DWI Fusion Axial Image: marked restriction on extravertebral soft tissue component surrounding the vertebrae without cortical disruption - wraparound sign.
 
Puncture of the extra vertebral component, under CT-Fluoroscopy, for cytological study.
 
Paravertebral soft tissue percutaneous CT-Fluoroscopy biopsy.
 
CT-Fluoroscopy vertebral body biopsy. No bone abnormalities on the CT images are seen; biopsy was performed at the site with MRI signal changes.
 
Bone fragment, with a diffuse towel of small centrocytes, in the medullary spaces.
 
Prominent lymphoid infiltration of paravertebral soft tissue with nodular pattern.
 
Bone fragment: lymphoid infiltrate composed by small centrocytes.
 
Hight-power field of neoplastic follicle with solid aggregates of centroblasts.
 
Immunohistochemical stain for CD20, highlights numerous B cells and the follicular pattern
 
Immunohistochemical stain for bcl-2, highlights the neoplastic follicles.
 
Immunohistochemical stain for CD21 highlights follicular dendritic cell meshworks within neoplastic follicles
 
 
 
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