Symmetric bony involvement of the lower extremities with lymphoma demonstrated on gallium scintigraphy

Primary or secondary lymphoma of the bone is uncommon. The sites of bony involvement include, in decreasing order of frequency, the spine, long bones, pelvis, ribs, and skull. A 66-year-old man with an atypical lineage of B-cell non-Hodgkin lymphoma is presented. The unusual initial presentation of the lymphoma included symmetric bony involvement of bilateral tibiae and the distal right femur, demonstrated on gallium-67 scintigraphy. The patient subsequently demonstrated resolution of the gallium-avid disease after treatment with fludarabine, cyclosporine, and ATG. This case also demonstrates the limitations of plain radiograph and the usefulness of MRI in the diagnosis of bony lymphoma.