Lymphoma presenting as a musculoskeletal soft tissue mass: MRI findings in 24 cases

The purpose was to describe the MRI morphological features and signal intensity (SI) characteristics of 24 histologically proven cases of musculoskeletal soft tissue lymphoma presenting clinically as a suspected primary soft tissue sarcoma. This was a retrospective review of clinical notes and MRI studies of 24 patients with a histologically confirmed diagnosis of lymphoma. All patients presented to a specialist orthopaedic oncology unit with a suspected primary soft tissue sarcoma. Features assessed included lesion size and morphology, location, extension across anatomical compartments and signal intensity characteristics. The lesions were predominantly poorly defined with peritumoral oedema in ten cases. All tumours were of intermediate T1W SI, while 85% of lesions also showed intermediate T2W SI. Almost all cases that were located just deep to the fascia showed subcutaneous extension, while 50% had involvement of more than one muscle compartment. In 29% of cases, there was extension of tumour along the neurovascular bundle. Histo-pathologically, 23 lesions were non-Hodgkin's B-cell lymphoma. The MRI features of primary musculoskeletal soft tissue lymphoma include a mass with intermediate SI on T1W and T2W images, involvement of more than one anatomical compartment, subcutaneous extension and extension along the neurovascular bundle.