PMC9766854_01
Chest radiography showing bilateral interstitial syndrome predominating in the bases. A computed tomography (CT) scan: micronodules with lymphatic distribution in both lungs with clavicular, mediastinal and abdominal lymph nodes and dysmorphic micronodular liver
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F1
A computed tomography (CT) scan: multiple lytic, sclerotic and mixed bone lesions of C7,D8,D9,D11,S1 vertebra and iliac bone. Aggressive lytic lesion of frontal bone and 6th right rib.
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F2
Moreover, the computed tomography of the body revealed a multiple mixed, lytic and sclerotic bone lesions with with suspicious signs of malignancy in 7th cervical vertebrae, thoracic vertebrae, 1st and 2nd Sacral vertebra, 6th,9th, tenth right ribs, costal cartilage of the 6th left ribs and a lytic lesion of the frontal bone (figure 2).
MRI sequences:T1,Stir,T1 after gadolinium injection: multiple infiltrative bone lesions hypointense on T1, hypointense on STIR surrounded by an hyperintense border. These lesions are mildly enhanced after gadolinium injection
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F3
Costo-vertebral biopsy (6th right rib)
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F4
CT, histological confirmation of bone lesions was needed. Costovertebral biopsy dismissed the diagnosis of malignancy and confirmed the granulomatous inflammation without caseous necrosis (figures 4, 5).
Histological examination of biopsy specimens from the costo-vertebra (A: hematoxylin and eosin) reveals an epithelioid granuloma and a gigantocellular granuloma in a medullary space under chondral. B: non-necrotizing granulomas compatible with bone sarcoidosis (Haematoxylin and Eosin).
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F5
CT, histological confirmation of bone lesions was needed. Costovertebral biopsy dismissed the diagnosis of malignancy and confirmed the granulomatous inflammation without caseous necrosis (figures 4, 5).