PMC5463129_01
Plain X-ray of the right hip with normal soft tissues and satisfactory position of prosthesis.
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fig1
Plain X-rays of the hip were normal (Figure 1) and further cross-sectional CT imaging demonstrated a cystic mass closely related to the hip prosthesis suggesting an inflammatory pathology (Figure 2).
CT scan of the pelvis showing a cystic lesion in close proximity to the femoral stem suggesting an inflammatory pathology.
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fig2
Plain X-rays of the hip were normal (Figure 1) and further cross-sectional CT imaging demonstrated a cystic mass closely related to the hip prosthesis suggesting an inflammatory pathology (Figure 2).
(a) Te99 bone scan showing increased uptake suggestive of infection. (b and c) The hypervascular abnormality on the early images would be in keeping with a soft tissue abscess with a necrotic centre, possibly related to infection of the right hip prosthesis.
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fig3
Te99 and SPECT (Single Photon Emission Computed Tomography) showed a large an area of intense hypervascularity at the medial aspect of the right proximal femur (Figures 3(a), 3(b), and 3(c)). The MRI scan revealed huge lesion with solid components and areas of liquefaction necrosis involving the periarticular hip region (Figures 4(a) and 4(b)).
(a) T2 weighted images showing a lesion with central liquefaction necrosis. (b) T2 weighted images showing the close proximity of the lesion to the medial side of the prosthesis with effusion into the joint.
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fig4
Te99 and SPECT (Single Photon Emission Computed Tomography) showed a large an area of intense hypervascularity at the medial aspect of the right proximal femur (Figures 3(a), 3(b), and 3(c)). The MRI scan revealed huge lesion with solid components and areas of liquefaction necrosis involving the periarticular hip region (Figures 4(a) and 4(b)).
Medium sized atypical lymphoid cells with large vesicular nuclei and prominent nucleoli, some showing a hint of plasmacytoid differentiation.
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fig5
Histopathology of the specimen demonstrated sheets of atypical lymphoid cells with a hint of plasmacytoid differentiation (Figure 5).
Immunostains showing positivity with CD138 (a), MUM 1 (b), PAX 5 (c), and EBV ISH (d) confirming diffuse large B cell lymphoma.
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Immunostains showed the neoplastic cells to express CD138, MUM 1, PAX5, and EBV ISH (Figures 6(a), 6(b), 6(c), and 6(d)).