Abstract
Primary bone lymphoma is a very rare and surprising diagnosis. We present a case of 37years old woman with primary sacral diffuse large B-cell lymphoma (DLBCL), supplemented with images from imaging studies and histopathological report.
Patient suffered from spontaneous fractures and pain for several years prior to the last hospitalisation. She underwent analysis of biochemical profile and blood count, a three-phase bone scintigraphy, pelvic CT and MRI.
Biopsy from sacral bone was processed as formalin-fixed paraffin-embeded blocs (FFPE), sections were stained by standard and immunohistochemical methods. 18F-FDG PET/CT scan was performed for lymphoma staging. Three-phase bone scintigraphy did not show abnormity in blood circulation or tissue perfusion in the course of the first and second phase.
However, in the delayed phase, we observed an accumulation defect with rim of higher radiotracer accumulation on SPECT/low dose CT corresponding to osteolytic focus with rim of increased bone remodelling. Histopathological examination led to diagnosis of DLBCL, germinal center B-cell like (GBC-like) subtype.
A three-phase bone scintigraphy significantly helped to disclose DLBCL in atypical location. Early diagnosis of DLBCL was followed by appropriate treatment, which resulted in stabilization of disease.