Bone Pathology Database

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2nd image
AP view - the midline cortical defect in the center is a previous biopsy
X rays show a sclerotic tibial shaft. MRI (not show here) showed there was perosteal inflammation.
A diffuse sclerotic response as seen here could be
1) Chronic osteomyelitis
2) Sclerotic primary tumour eg osteosarcoma, adimantinoma
3) Metastasis eg Prostate
4) Lymphoma - often a lytic tumour, but may be sclerotic as in this case.

X RAY features of lymphoma of bone: Findings vary so much that none are considered characteristic. Extensive, involving 25-50% of affected bone, sometimes entire bone. Destructive lesion: radiolucent, mottled, patchy, motheaten and sometimes the outline of the bone is complete lost. Infiltrative , permeative, poorly defined interface with normal bone. 50% have a mixture with small areas of sclerosis. Nearly all destroy cortical bone and 25% thicken the cortex. Often large, obvious soft-tissue extension. Periosteal new bone formation uncommon. Sclerosis may preceed diagnosis by several years and in flat bones may resemble Paget's. When confined to marrow cavity, plain x-ray negative but bone scan and MRI positive. A classic presentation of Hodgkins disease in bone is the solitary ivory vertebra. 25% present with pathologic fracture

Re biopsy was done TBH -lymphoma - B cell type
Treated with chemotherapy and radiotherapy to the tibia.

Record 61