case_images: PMC11440879_01
case_images: MRI (T1-T2) undergone in July 2022 showed disc disease in L2-L3 and especially L3-L4 (wihte arrow), the latter discreetly reducing the diameter of the canal, with a relative secondary narrowing of the canal. (A) The MRI carried out in December 2023 showed bone marrow replacement almost the entire L3-vertebral body in both phases (long white arrow), and an inflammatory/infectious spindle extending anteriorly and posteriorly, with suspected epiduritis. (B) A merged image of 18F-FDG-PET and MRI showed aggressive widespread invasion at the L3 and doubtful at the L3-L4 level intervertebral disc, with an onfectious appearance and metabolic extension anteriorly and posteriorly (head arrow), associated with epiduritis (C).
case_images: fnume-04-1402552-g001.jpg
case_images: PMC11440879_01_fnume-04-1402552-g001.jpg
case_images: F1
case_images: She had previously undergone an MRI of the spine in favor of a narrow lumbar canal (Figure 1A), for which she was treated with multiple analgesics and infiltrations until the summer of 2023, with an improvement of the symptomatology. She underwent an MRI, which revealed a very dubious image showing remodelling of the L3 vertebra (bone marrow replacement) and of the intervertebral disc between L3 and L4, suggesting suspected spondylitis vs. spondylodiscitis (Figure 1B).
case_images: 18F-FDG-PETCT showing higher uptake and extensive invasion at the L3 vertebral level and questionable invasion at the L3-L4 intervertebral disc level (white arrow), with an "inflammatory cast" appearance (black arrow) and more aggressive metabolic extension anteriorly and posteriorly in maximum intensity projection (MIP) (A,B) and merged images (C) than CT (D) in addition, no other lesions were found in the rest of the body explored.
case_images: fnume-04-1402552-g002.jpg
case_images: PMC11440879_01_fnume-04-1402552-g002.jpg
case_images: F2
case_images: In view of her symptoms and recent weight loss, she also underwent an 18F-FDG-PET/CT showing a higher uptake in this widespread invasion at the L3 level with an infectious appearance and more aggressive metabolic extension anteriorly and posteriorly, associated with epiduritis (Figure 2).
case_images: Biopsy of infiltrating lesion of the L3 vertebra showing aggressive DLBCL. Immunostaining of the lesion is positive for haematoxylin-eosin HE (A), CD20+ (B), KI-67 (C), and BCL2 (D).
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case_images: PMC11440879_01_fnume-04-1402552-g003.jpg
case_images: F3
case_images: IV (Ann-Harbor classification). Immuno-histochemical were as follows: CD20+, PAX5+, CD3/CD5 -, BCL6+, MUM1-, Cycline D1-, BCL2+, cMyc-, Ki-67 80%, consistent with DLBCL, non-germinal center B-cell like (Figure 3).
case_images: 18F-FDG-PET/CT showing complete metabolic response/normalization at L3 vertebra level and the L3-L4 intervertebral disc after 4 cycles of chemotherapy (white arrows).
case_images: fnume-04-1402552-g004.jpg
case_images: PMC11440879_01_fnume-04-1402552-g004.jpg
case_images: F4
case_images: Chemotherapy (R-CHOP and methotrexate) was administered to the patient with clinical, morphologic, and metabolic improvement after 4 cycles (Figures 4, 5).
case_images: (A) The follow-up MRI realized in March 2024 showed traces of the laminectomy performed on L3, a clear reduction in tumour infiltration of the vertebral body of L3 in both phases (hypo-signal in T1 and hypersignal in T2-phase, white arrows) with pathological compaction (lost of height: 10 mm), and a reduction in the inflammatory spindle which extended anteriorly and posteriorly. The L3-L4 intervertebral disc remains reshaped but no longer shows associated enhancement (yellow head arrow). (B) A merged image of 18F-FDG-PET and MRI showed a complete metabolic response at the L3 vertebra and L3-L4 intervertebral disc after 4 cycles of chemotherapy.
case_images: fnume-04-1402552-g005.jpg
case_images: PMC11440879_01_fnume-04-1402552-g005.jpg
case_images: F5
case_images: Chemotherapy (R-CHOP and methotrexate) was administered to the patient with clinical, morphologic, and metabolic improvement after 4 cycles (Figures 4, 5).