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Clinical History:
This 92-year-old female presented to clinic with chronic right shoulder swelling and pain of several months duration which had become more severe in last 10 days. Her past history includes a diagnosis of lymphoma in the early 1980’s—a non-Hodgkin stage IIE variety with favorable histologic status. She underwent 4 cycles of CHOP therapy followed by radiation treatment. Lymphomatous involvement was initially found in her right salivary gland, right submandibular gland, and left inner cheek. Plain film radiographs and the illustrated MR examination of the patient’s right arm revealed an ill-defined mass involving right humeral metaphysis.
Diagnosis:
Osseous lymphoma (Large B-Cell type)
MR Technique:
Scans were acquired on a Siemens 3 T Trio Tim MR unit. Sequences obtained included (A) coronal spin echo T1-weighted (TR/TE 700/10 ms, scan time 3:42 min:sec, slice thickness 5 mm) and (B) post contrast turbo spin echo fat-suppressed T1-weighted (TR/TE 842/10 ms, scan time 4:28 min:sec, slice thickness 5 mm) images.
Imaging Findings:
A prominent soft tissue mass is seen enveloping the proximal humerus with an associated pathologic fracture in the region of the surgical neck. This large soft tissue mass is isointense to muscle on T1-weighted images, measuring approximately 15 x 8.5 x 9.1 cm. Postcontrast images demonstrate diffuse enhancement. The mass is centered on the proximal humeral shaft, extending superiorly to involve the coracoid process.
