GENG Yan-hua, WANG Chang-xing, TAN Yan-bin

XU Xiao-ming, CAO Yuan, LIU Zi-yu and LI Yan-qing

     Primary Hodgkin disease (HD) of bone is rare. The recognition on it is relatively confined. Both cases arising in male adults were suspected to be Potts disease (spinal tuberculosis) on imaging, and pathologic misdiagnosed initially. The clinical situations rapidly aggravated. The pathomorphology was remarkable malignant changed. They shared similar process in clinical, radiological and diagnostic process and could be representative. We retrospectively analyzed correlative results of them and review points of distinction from other disease entities that might be confused with it.
      Patient 1 is a 44-year-old male, he felt intermittent chest-back pain for months. The pain was dull but sharpened with coughing. He was diagnosed with bone tuberculosis based on local radiological findings, but did not respond to tuberculosis medications. Physical examination showed a slight tenderness and percussion pain at the fourth and fifth dorsal vertebrae. Muscle strength was decreased and tendon reflexes were unremarkable. Computed tomography (CT) images showed bony destruction of the fifth dorsal vertebra, it was flattened to slight wedge shape with intact cortical bone and hyperostosis at the edges (Figure 1A). The intervertebral space was close to normal. Magnetic Resonance Imaging (MRI) showed the lesion involved right vertebral pedicle and paravertebral soft tissue. Abnormal signals can be observed in 4th to 6th and 11th vertebras, the anterior border and intraspinal canals of the 4th to 6th vertebrae with significant Gadolinium enhancement. The radiologic impression was multifocal spinal tuberculosis, but metastatic disease needed to rule out by MRI. A surgical curettage of the fifth dorsal vertebral lesion was performed.