PMC3773517_01
T1 gadolinium-enhanced fat suppressed MRI of (A) L5-S1 and (B) L3 paravertebral mass (arrowheads) with neuroforaminal involvement (arrow). FDG-PET/CT showing increased F18-FDG uptake adjacent to the T10-L3 vertebrae (arrows), and reduced uptake in irradiated vertebral bodies (*) seen in (C) axial and (D) coronal planes. (E) H&E, (F) CD3 and (G) CD20 immunohistochemistry of biopsy of L5 paravertebral mass.
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F1
MRI showed enhancement of the paravertebral soft tissues adjacent to the L5-S1 vertebrae with neuroforaminal involvement (figure 1A). IgM monoclonal protein was detected in serum and bone marrow biopsy demonstrated plasmacytoid lymphocytes. Image guided biopsy of the abnormal L5 paravertebral tissue confirmed lymphoplasmacytic lymphoma/Waldenstrom's macroglobulinaemia (WM) (figure 1E:G). Repeat MRI showed abnormal enhancement in paravertebral soft tissues adjacent to the T10-L3 vertebrae with bilateral foraminal involvement (figure 1B). Positron emission tomography/CT (PET/CT) demonstrated abnormal FDG uptake in paraspinal tissues adjacent to the T10-L3 vertebrae distinct from vertebral bone marrow uptake and marked hypometabolism in previously irradiated lumbosacral vertebrae (figure 1C,D).