Disclosures: Catherine A. Mills, MD, BA: No financial relationships or conflicts of interest

Case Diagnosis: Two active females presenting with radiating buttock pain were ultimately diagnosed with diffuse large B-cell lymphoma (DLBCL) with bone and soft tissue involvement.

Case Description: 1: 39 yo female presented with right lumbar, buttock and leg pain, consistent with radicular pain. Imaging of the spine was unremarkable. Pain was persistent despite physical therapy (PT) and progressed to involve the hip; intraarticular injection provided only diagnostic improvement. Subsequent pelvis MRI revealed masses with invasion into the right iliac wing, sacrum, and acetabulum. 2: 67 yo female with a history of remote breast cancer presented with pain in right buttock and leg with concomitant foot drop. Lumbar spine MRI and EMG revealed severe degenerative disease and acute L5 radiculopathy. Oral steroids, PT, and epidural steroid injection provided limited relief. Physical examination at follow-up notable for a palpable mass in the right gluteal region. MRI of the right hip revealed masses within the posterior right hip musculature encasing the sciatic nerve.

Setting: Outpatient musculoskeletal/pain practice.Assessment/

Results: In both cases, biopsy confirmed the diagnosis of DLBCL. Patients were referred to Oncology. 1: Patient has begun chemotherapy. 2: Patient completed chemotherapy and radiation, with remission.

Discussion: Gluteal pain is notoriously problematic, with a variety of potential etiologies including referred pain from the lumbar spine, hip, pelvis, and musculature. DLBCL accounts for 24% of non-Hodgkin lymphoma (NHL) cases in the US. It is an aggressive malignancy with survival on the matter of months if untreated. Treatment with chemoimmunotherapy leads to remission in > 50% of patients. Musculoskeletal DLBCL is exceedingly rare, with primary muscle and bone accounting for 1% and 2% of cases, respectively. Given the aggressive nature of DLBCL and the success of treatment, early identification and treatment is key.

Conclusion: It is critical to maintain a broad differential for gluteal pain, especially when symptoms are persistently refractory to typical management.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/diffuse-large-b-cell-lymphoma-masquerading-as-hip-spine-syndrome/