| CASE REPORT |
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| Year : 2018 | Volume
: 1
| Issue : 2 | Page : 135-139 |
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Hyperplastic hematopoietic bone marrow of the spine mimicking spinal metastasis: A case report and review of literature
Wen Loong Paul Yuen, Wenxian Png, Shree Kumar Dinesh, Wee Lim Loo
Department of Orthopedic Surgery, Changi General Hospital, Singapore 529889, Singapore
Correspondence Address:
Dr. Wen Loong Paul Yuen
Department of Orthopedic Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889
Singapore
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/isj.isj_5_17
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Magnetic resonance imaging (MRI) has a high sensitivity for detecting metastatic bone tumors. However, distinguishing metastasis from benign lesions can be difficult. We report a case of hyperplastic hematopoietic bone marrow of the spine mimicking spinal metastasis. A 73-year-old male presented to the orthopaedic clinic with worsening back pain following a fall. Initial radiographs demonstrated a compression fracture of the T11, L1, and L2 vertebral body. MRI showed multiple scattered hypointense foci within the lumbar spine suspicious for osseous metastases, with old-healed fractures at T11, L1, and L2. Whole spine imaging was then performed demonstrating similar marrow signal abnormality in the cervical and thoracic spine. Initial suspicion for a pathological fracture secondary to bony metastasis was strong. Subsequent screen for malignancy was negative. Open biopsy was done on the T4 vertebra, and the histopathological diagnosis was spinal hyperplastic hematopoietic bone marrow. This condition is characterized by reconversion of fatty marrow to hematopoietic marrow, which can occur in chronic anemia, obesity, heavy smokers or following trauma. This case illustrates a rare differential diagnosis for suspected metastatic bone tumor, and our report discusses the important radiologic differences between both conditions.
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