Diffuse large B-cell lymphoma. Back pain. History of skull base mass. The marrow is heterogeneous with widely distributed areas of T1-hypointense, T2-hyperintense, contrast-enhancing signal. This focality is most pronounced at C5 vertebral body, T1 spinous process, T10 vertebral body, the medial end of the right 11th rib, T12 spinous process, L1 vertebral body, L4 vertebral body as well as the sacral ala and iliac bones. However, there is no osseous expansion, pathologic fracture or epidural involvement. Alignment is anatomic. The vertebral bodies are present in height. There is mild upper/mid cervical disc desiccation. There is a small central disc protrusion at T8-T9 which abuts the ventral aspect of the spinal cord. The spinal canal is preserved. There is no significant neural foraminal stenosis. The spinal cord shows normal signal. The conus medullaris has normal shape and signal and its tip lies at L1 level. While the spinal cord itself shows no abnormal contrast enhancement, there is nodular contrast enhancement along the cauda equina roots, which may reflect leptomeningeal involvement but is nonspecific otherwise.Central skull base involvement is only partly included as well as the right sigmoid sinus/internal jugular venous thrombosis. Please refer to the recent brain MRI from May 25, 2016 for more details. Asymmetry of the tongue with increased fatty signal in its right side probably reflect denervation from the skull base involvement. There is less pronounced asymmetry in the larynx, also suggestive of right recurrent laryngeal nerve paresis's as well as atrophy of the soft tissues in the right side of the neck which may relate to intracranial involvement. A large right hilar mass as well as multiple mildly enlarged mediastinal lymph nodes are only partly included. In addition, there are multiple small retroperitoneal lymph nodes.
1.There is diffuse abnormal marrow signal with more pronounced involvement at some levels as described above. There is however, no associated osseous expansion, pathologic fracture or epidural soft tissue component. In this clinical setting, this would be compatible with lymphomatous involvement of the marrow although without gross destruction.2.While there is no abnormal spinal cord signal or contrast enhancement, there is nodular contrast enhancement along the cauda equina nerve roots, compatible with a leptomeningeal process. The finding is otherwise nonspecific and while here it may represent lymphomatous involvement of the leptomeninges, it can also be seen with other inflammatory/infectious processes.3.Multilevel degenerative spondylosis is mild.4.Large right hilar mass and mildly enlarged mediastinal lymph nodes are only partly included. Also, involvement of the central skull base and associated venous thrombosis are only partly included.