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Primary bone lymphoma without classic nodal lesions or advanced disease may be mistaken for other osseous diseases, especially when involving a single bone site. In this patient, a series of imaging modalities including MRI, bone scan, and 18F-FDG PET/CT revealed only 1 solitary osseous lytic lesion with abnormal uptake in the third thoracic vertebra, suggesting a primary skeletal malignancy. The subsequent histopathologic examination confirmed the diagnosis of diffuse large B-cell lymphoma. After chemotherapy, he achieved an excellent clinical and metabolic response.