EURORAD ESR

Case 8974

Diffuse large B-cell lymphoma of the femur with extensive involvement of adjacent soft tissues

Author(s)
Mantarro A, D'Errico L, Bemi P, Vagli P, Caramella D, Bartolozzi.
Dipartimento di Radiologia Diagnostica ed Interventistica
Università di Pisa
 
Patient
female, 79 year(s)
 
 
  • Figure 1
    Physical examination
     

    Right leg swelling with extensive antero-lateral hyperaemia.

     
    Area of Interest: Musculoskeletal system; Special Focus: Haematologic diseases; Lymphoma;

    Right leg swelling with extensive antero-lateral hyperaemia.

     
    Area of Interest: Musculoskeletal system; Special Focus: Haematologic diseases; Lymphoma;

    Right leg swelling with extensive antero-lateral hyperaemia.

     
    Area of Interest: Musculoskeletal system; Special Focus: Haematologic diseases; Lymphoma;
     
     
  • Figure 2
    Ultrasound examination
     

    Conspicuous right knee effusion involving superior recesses; synovial hypertrophy; hypoechoic mass in the middle-distal region of femur, displacing the middle, medial and lateral vast.

     
    Area of Interest: Musculoskeletal joint; Musculoskeletal system; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Oedema;

    Conspicuous right knee effusion involving superior recesses; synovial hypertrophy; hypoechoic mass in the middle-distal region of femur, displacing the middle, medial and lateral vast.

     
    Area of Interest: Musculoskeletal system; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure;
     
     
  • Figure 3
    Right femoral radiography

    Macular dishomogeneous structure of the femoral distal region, resulting from osteolytic lesions. Cortical erosions of the distal metaphyseal external surface.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal system; Imaging Technique: Conventional radiography; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 4
    Right femoral CT
     

    Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Demineralisation-Bone; Lymphoma;

    Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Demineralisation-Bone; Lymphoma;

    Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: CT-High Resolution; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Macular dishomogeneous structure of the femoral distal region, resulting from osteolytic lesions. Cortical erosions of the distal metaphyseal external surface.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal system; Imaging Technique: CT-High Resolution; Special Focus: Lymphoma;
     
     
  • Figure 5
    Right femoral MR
     

    T1 hypointense diffuse lesions in the middle and distal region of the femur, with medullar and cortical involvement.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    T2 hyperintense diffuse lesions in the middle and distal femur, with medullar and cortical involvement. The extension towards the soft tissues is best resolved on T2 sequence, allowing better detection of periosteal...

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Newly formed tissue, surrounding the femur, displays low signal interrupted by high-signal areas on T2.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;

    Short tau inversion-recovery (STIR) fat suppression sequences yield signal enhancement on T1 and T2.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal soft tissue; Musculoskeletal system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Lymphoma;
     
     
  • Figure 6
    CT-guided biopsy
     

    CT-guided biopsy of the pathologic tissue by antero-lateral access.

     
    Area of Interest: Musculoskeletal bone; Musculoskeletal system; Imaging Technique: CT-High Resolution; Procedure: Biopsy; Diagnostic procedure; Special Focus: Lymphoma;

    Standard histological analysis (ematoxilin-eosin staining; E.E.) and immunohistochemical evaluation of CD20 and Ki67.

     
    Area of Interest: Oncology; Procedure: Biopsy; Diagnostic procedure; Molecular imaging; Special Focus: Lymphoma;
     
     
  • Figure 7
    Whole-body staging CT
     

    Multiple lung nodules (up to 4-cm diameter) compatible with metastases.

     
    Area of Interest: Lung; Thorax; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Multiple lung nodules (up to 4-cm diameter) compatible with metastases.

     
    Area of Interest: Lung; Thorax; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    A lung nodule involving the right hilum.

     
    Area of Interest: Lung; Thorax; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.

     
    Area of Interest: Abdomen; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.

     
    Area of Interest: Abdomen; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.

     
    Area of Interest: Abdomen; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.

     
    Area of Interest: Abdomen; Spleen; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Involvement of right iliac chain lymph nodes (up to 2.7-cm maximum diameter).

     
    Area of Interest: Lymph nodes; Pelvis; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Involvement of right iliac chain lymph nodes (up to 2.7-cm maximum diameter).

     
    Area of Interest: Lymph nodes; Pelvis; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;

    Involvement of right femoral and inguinal lymph nodes (up to 2.7-cm maximum diameter).

     

    Involvement of right femoral and inguinal lymph nodes (up to 2.7-cm maximum diameter).

     
    Area of Interest: Lymph nodes; Pelvis; Imaging Technique: CT-High Resolution; Procedure: Contrast agent-intravenous; Staging; Special Focus: Metastases;
     
     
Right leg swelling with extensive antero-lateral hyperaemia.
 
Right leg swelling with extensive antero-lateral hyperaemia.
 
Right leg swelling with extensive antero-lateral hyperaemia.
 
Conspicuous right knee effusion involving superior recesses; synovial hypertrophy; hypoechoic mass in the middle-distal region of femur, displacing the middle, medial and lateral vast.
 
Conspicuous right knee effusion involving superior recesses; synovial hypertrophy; hypoechoic mass in the middle-distal region of femur, displacing the middle, medial and lateral vast.
 
Macular dishomogeneous structure of the femoral distal region, resulting from osteolytic lesions. Cortical erosions of the distal metaphyseal external surface.
 
Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric alterations.
 
Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric alterations.
 
Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric alterations.
 
Decalcification of medullary bone matrix; periosteal bone spicules protruding towards soft tissues; muscular isodense masses with regular margins surrounding the femur; vastus medialis swelling without densitometric alterations.
 
Macular dishomogeneous structure of the femoral distal region, resulting from osteolytic lesions. Cortical erosions of the distal metaphyseal external surface.
 
T1 hypointense diffuse lesions in the middle and distal region of the femur, with medullar and cortical involvement.
 
T2 hyperintense diffuse lesions in the middle and distal femur, with medullar and cortical involvement. The extension towards the soft tissues is best resolved on T2 sequence, allowing better detection of periosteal and cortical lesions.
 
Newly formed tissue, surrounding the femur, displays low signal interrupted by high-signal areas on T2.
 
Short tau inversion-recovery (STIR) fat suppression sequences yield signal enhancement on T1 and T2.
 
CT-guided biopsy of the pathologic tissue by antero-lateral access.
 
Standard histological analysis (ematoxilin-eosin staining; E.E.) and immunohistochemical evaluation of CD20 and Ki67.
 
Multiple lung nodules (up to 4-cm diameter) compatible with metastases.
 
Multiple lung nodules (up to 4-cm diameter) compatible with metastases.
 
A lung nodule involving the right hilum.
 
Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.
 
Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.
 
Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.
 
Several focal splenic hypodense lesions (from few mm to 2-cm diameter), compatible with metastases.
 
Involvement of right iliac chain lymph nodes (up to 2.7-cm maximum diameter).
 
Involvement of right iliac chain lymph nodes (up to 2.7-cm maximum diameter).
 
Involvement of right femoral and inguinal lymph nodes (up to 2.7-cm maximum diameter).
 
Involvement of right femoral and inguinal lymph nodes (up to 2.7-cm maximum diameter).
 
 
 
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