Radiologic manifestation of histiocytic lymphoma in the skeletal and central nervous system

The radiographic manifestation of histiocytic lymphoma in the skeletal and central nervous system of 112 non-selected patients were reviewed in a retrospective study. Histiocytic lymphoma metastatic to bone and brain are late manifestations of the disease occurring in 15 and 4%, respectively. Involvement of the spinal cord and nerve roots is found in 6% and represents often the initial manifestation of the disease. Histiocytic lymphoma of brain presents angiographically as avascular mass without site predilection and on contrast enhanced computer tomography as hyperdense lesion without necrotic center. On myelography an extradural mass or complete block is found. The most common skeletal locations are spine, pelvis, rib and femur. The ratio of multifocal to unifocal skeletal manifestations is approximately 2 to 1. The radiographic appearance varies from completely lytic, often associated with a soft tissue mass, to osteoblastic, often with Pagetoid features. Early recognition of histiocytic lymphoma manifestations is important to guarantee prompt institution of appropriate therapy since the disease can progress extremely rapidly.