Key result
Biopsy reveals diffuse large B-cell lymphoma in a suspected warfarin-induced psoas hematoma.
Why the study?
Skeletal muscle lymphoma is rare and can mimic other conditions such as hematoma, making accurate diagnosis and subtype determination important for treatment.
Case Report (n=1)
No
Highlights the clinical pitfall that skeletal muscle lymphoma can mimic an acute intramuscular hematoma on MRI, particularly in patients on anticoagulation therapy.
Biopsy is warranted for psoas masses mimicking hematoma on MRI in anticoagulated patients; this case report leaves open broader applicability.
An 84-year-old Japanese man taking warfarin to prevent cerebral infarction secondary to atrial fibrillation was admitted to our hospital for evaluation of a painless right back mass. Magnetic resonance imaging (MRI) showed an oval-shaped mass in the right psoas major muscle. The mass showed high intensity on T1-, T2-, and diffusion-weighted imaging and mimicked an acute-phase hematoma. However, it showed no chronological changes typical of a hematoma, and MRI revealed enlargement of the mass 1 week after admission. Histopathological examination of a biopsy specimen revealed diffuse large B-cell lymphoma (DLBCL). Although skeletal muscle lymphoma is rare, physicians should be familiar with its MRI characteristics. In addition, determination of the lymphoma subtype has important implications for the treatment of skeletal muscle lymphoma because DLCBL may have an especially poor prognosis.
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Akuzawa et al. (2017) conducted a case report in Malignant lymphoma of the psoas major muscle (n=1). Malignant lymphoma presenting as an intramuscular mass was evaluated on Histopathological diagnosis. MRI of a psoas major mass in an 84-year-old man on warfarin mimicked a hematoma, but the lesion was definitively diagnosed via biopsy as diffuse large B-cell lymphoma.
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