primary lymphoma LSBU

Description: 30 year old female and a recent immigrant from the Sudan, admitted complaining of a 3 week history of pain and swelling in the right ankle. The superficial clinical features resembled an osteomyelitis.
The plain films show a destructive process expanding the distal metaphysis of the right tibia. The endosteal margin of the process is ill-defined. There is undercutting of the cortex of the metaphysis. There is a lamellar periosteal reaction in the same region. The medullary lucency extends proximally to the mid-diaphysis in the original images, where there is significant cortical tyhickening, particularly on the medial side of the diaphysis. The diaphyseal thickening and deformity was originally assumed old fracture. There is a soft tissue mass, clearly defined against the visible normal soft tissue on the medial side. The soft tissue planes are preserved, however. The isotope scans show a focus of intense activity over the distal half of the left tibia.
The MRI shows a soft tissue tumour destroying bone and extending medially into the adjacent soft tissues. The extension up the diaphysis is indicated by the lack of fat signal in the medulla of the right tibia. There is no visible free fluid.