Bone Pathology Database

Teaching Version


Text in Italics is general (instructional) information

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2nd image
X Ray
Third image
X Ray
4th image
The Chest X ray shows enlargement of the hilar lymph nodes and widening of the mediastinum. The lateral of the thoracic spine shows collapse of T12 with no loss of disc space. Plain X rays show vertebra plana ( "vertebra nigrans" ) of T12 with normal disc space. Magnetic resonance confirms the collapse of T12 with anterior bulging onto the spinal cord.

Management A thorocotomy was undertaken (skin clips from this procedure are seen in the middle X ray) and an anterior decompression of T12 was done. Biopsy showed sheets of larger cells, biopsy of an axillary node also showed this picture,as well as "hallmark" cells - a cell with a bean shaped nucleus were common. The final diagnosis was an anaplastic large cell (a T cell type ) lymphoma.

Vertebra plana is seen in:-

Lymphomas can be divided into two groups Hodskins and Non Hodskins (NHL)

this is a case of Non Hodskin's Lymphoma

three types of NHL that occur most often in children are:

The appearance of large fields of uniform cells in the histology of this case, had to be differentiated from Ewings or a PNET tumour


Facts about Non Hodskins Lymphoma

Prognosis Glotzbecker (JBJS Vol88-A (3) Page 583)

"On the basis of 306 NHL lymphomas in children and a comprehensive review of similar series in the literature involving
patients with primary lymphoma of bone, it appears that younger age, advanced-stage disease, multiple-bone involvement,
and non-large-cell histology are associated with decreased survival as compared with older age, localized
disease, single-bone involvement, and large-cell histology, respectively."


Record 115