obtained on the femoral lesion, I will forward to the group.
———- Forwarded message ———
From: <drubin001@gmail.com>
Date: Thu, Jan 20, 2022 at 3:45 PM
Subject: RE: What do you think?
To: <ptirmanmd@gmail.com>
Hi Phil –
Sorry I’m late to the party. The distal femur bothers me for being an
inflammatory lesion related to RA, both because it is some distance from
the joint and because it lacks surrounding marrow edema/osteitis. Patients
with RA have an increased risk of lymphoma, and both methotrexate and
anti-TNF alpha agents are probably independent risk factors for lymphoma.
That would be one malignancy that could look like this and still not be
completely unrelated fleas. I’m not a big proponent of fancy imaging (like
diffusion/ADC), probably because of my ignorance, but I suspect it might
help in this case. In/out of phase imaging might distinguish a lesion like
lymphoma from an inflammatory one. Doubt IV contrast, CT, or bone scan
would help.
David Rubin
