Bone lesions of the tibia are encountered commonly in radiology practice.

The range of pathologies is large and it can be difficult to reach a diagnosis based upon conventional radiographic features alone. Cross-sectional imaging (CT and MRI) can help narrow down the differential and in many cases provide a definitive diagnosis.

We present a pictorial review of the imaging features a comprehensive range of pathologies involving the tibia on conventional radiography, CT and MRI and discuss features to aid accurate diagnosis.

Objective: To report a rare case of lymphomatous transformation in a Pagetic bone

Methods: A 61yr old lady with an 8yr history of monostotic Paget’s disease affecting her right proximal humerus presented with increasing right arm pain. Initial investigations including plain films, a radioisotope bone scan and MRI scan showed evidence of malignant transformation.

Results: The patient was admitted for an incision biopsy. Initial pathological examination suggested a high grade Paget’s sarcoma. However, further stains and immunohistochemical markers showed bone involvement by a malignant B-cell lymphoma.

Conclusion: Although sarcoma is by far the commonest malignant transformation of Pagetic bone, rare cases of lymphoma must also be considered, especially since the management and prognosis are radically different.