Lymphoma presenting as a musculoskeletal soft tissue mass: MRI findings in 24 cases

Abstract

The purpose was to describe the MRI morphological features and signal intensity (SI) characteristics of 24 histologically proven cases of musculoskeletal soft tissue lymphoma presenting clinically as a suspected primary soft tissue sarcoma. This was a retrospective review of clinical notes and MRI studies of 24 patients with a histologically confirmed diagnosis of lymphoma. All patients presented to a specialist orthopaedic oncology unit with a suspected primary soft tissue sarcoma. Features assessed included lesion size and morphology, location, extension across anatomical compartments and signal intensity characteristics. The lesions were predominantly poorly defined with peritumoral oedema in ten cases. All tumours were of intermediate T1W SI, while 85% of lesions also showed intermediate T2W SI. Almost all cases that were located just deep to the fascia showed subcutaneous extension, while 50% had involvement of more than one muscle compartment. In 29% of cases, there was extension of tumour along the neurovascular bundle. Histo-pathologically, 23 lesions were non-Hodgkin's B-cell lymphoma. The MRI features of primary musculoskeletal soft tissue lymphoma include a mass with intermediate SI on T1W and T2W images, involvement of more than one anatomical compartment, subcutaneous extension and extension along the neurovascular bundle.

Skeletal Muscle Involvement in B-Cell Lymphoma: Two Cases Illustrating the Contribution of Imaging to a Clinically Unsuspected Diagnosis

“…Suresh et al found that muscle lymphoma had a propensity to involve multiple muscle compartments, distinguishing it from most soft tissue sarcomas. Extension of muscle lymphoma into adjacent subcutaneous tissues was another interesting feature they reported and was seen in our first case presented [15]. Lymphoma can sometimes present with a focal muscle mass as opposed to an infiltrative ill-defined abnormality, but this is less common [16].…”

Anaplastic lymphoma kinase-negative anaplastic large cell lymphoma with extranodal involvement of the thigh muscle: a case report

“…The role of imaging studies in the diagnosis and treatment of muscle lymphomas has been discussed in various reports [6-8]. MRI is currently the most preferred method for the characterization of soft-tissue tumor.…”

Incidental findings in the skeletal musculature on computed tomography

“…[15][16][17] Intramuscular lymphomas can present as solid muscle lesions or as diffuse muscle enlargement. [15][16][17][18] The present study showed that in most cases (71.6%), IFs were not diagnosed at the time of CT investigations. Therefore, it is important to check the skeletal musculature in radiological investigations.…”