Question
A 58 year old man has six months of left hip pain, night sweats and weight loss. Radiographs show subtle permeative change in the ilium.
- Describe the MRI.
- What is the differential diagnosis of a permeative lesion in an adult?
- How is this lesion diagnosed and treated?
Answer
MRI
- Extensive marrow replacement in the left ilium with a soft tissue mass
- Large soft tissue component with relatively little cortical destruction
- Primary lymphoma of bone (diffuse large B cell)
Differential diagnosis
- Metastasis
- Myeloma
- Ewing sarcoma in younger patients
- Osteomyelitis
- Langerhans cell histiocytosis
Diagnosis
- Core biopsy with fresh tissue for flow cytometry
- Immunohistochemistry (CD20)
- PET CT staging
- Bone marrow biopsy
Treatment
- Chemotherapy (R-CHOP) with or without radiotherapy
- Surgery for pathological fracture or impending fracture only
- Five year survival about 70 to 80%
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.