title: A treacherous case of primary non-Hodgkin lymphoma of the bone: appearances can be deceptive.
abstract: BACKGROUND
  Primary lymphoma of the bone constitutes an extremely rare but distinctive clinical entity, accounting for approximately 3% of all primary bone malignancies and less than 1% of all non-Hodgkin lymphomas.
  
  
  METHODS
  We report a rare case of a male patient with an atypical clinical presentation of non-Hodgkin primary lymphoma of the bone, initially misdiagnosed as ankylosing spondylitis. To our knowledge, this is the first case in the literature in which magnetic resonance imaging was contra-indicated. The atypical radiological imaging of the tumor, despite its aggressiveness, rendered the diagnostic approach a challenging but strenuous process.
  
  
  CONCLUSIONS
  Plain radiographs and even computerized tomography images of primary lymphoma of the bone may appear as normal, but other imaging modalities should be used including radionuclide scans, especially when imaging techniques of greater accuracy such as magnetic resonance imaging are contraindicated. A patient-centred approach with emphasis on the main symptoms is the key to the diagnostic challenge of revealing the extremely unusual cases of primary lymphoma of the bone.
authors.affiliation: MD, 2nd Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece panyfan@hotmail.com.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Anyfanti
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Gouridou
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsinaridis
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bekiaropoulos
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Argyropoulos
authors.affiliation: MD, 2nd Propedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Sousos
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petrou
authors.affiliation: MD, Hematology Department and Bone Marrow Transplantation Unit, Papanikolaou General Hospital, Thessaloniki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Papathanasiou
authors.affiliation: MD, Radiology Department, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Anthi
authors.initials: A
authors.lastname: Morichovitou
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Damianidis
authors.affiliation: MD, 1st Department of Internal Medicine, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Spyros
authors.initials: S
authors.lastname: Bakatselos
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols; D044963:Biopsy, Fine-Needle; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D000075202:Contraindications; D003520:Cyclophosphamide; D003951:Diagnostic Errors; D004317:Doxorubicin; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011241:Prednisone; D000069283:Rituximab; D013167:Spondylitis, Ankylosing; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Non-Hodgin lymphoma; ankylosing spondylitis; diagnosis; magnetic resonance imaging; primary bone lymphoma