PET-CT case of the month (11/09): Extranodal Lymphoma
An 84 yrs old male with a past medical history of HTN and renal
insufficiency presented with one month history of swelling in the right hard
palate. He had difficulty lying on his right side due to pain but was otherwise
asymptomatic. Biopsy of the lesion revealed large B-cell lymphoma.
PET-CT was performed for whole body staging.
insufficiency presented with one month history of swelling in the right hard
palate. He had difficulty lying on his right side due to pain but was otherwise
asymptomatic. Biopsy of the lesion revealed large B-cell lymphoma.
PET-CT was performed for whole body staging.
PET-CT showed hypermetabolic soft tissue masses in the: right hard palate
(SUV 6.3), liver (SUV 8.0), and bilateral kidneys. Multiple bone lesions were
also seen involving: focus in the sternum, the left 7th rib posteriorly, and the
left transverse element of T8 vertebrae. No hypermetabolic
lymphadenopathy was seen on PET-CT (extranodal lymphoma). Due to the
unusual presentation liver biopsy was performed (to rule out a synchronous
primary), which also showed large B-cell lymphoma.
(SUV 6.3), liver (SUV 8.0), and bilateral kidneys. Multiple bone lesions were
also seen involving: focus in the sternum, the left 7th rib posteriorly, and the
left transverse element of T8 vertebrae. No hypermetabolic
lymphadenopathy was seen on PET-CT (extranodal lymphoma). Due to the
unusual presentation liver biopsy was performed (to rule out a synchronous
primary), which also showed large B-cell lymphoma.
1. Fluorine-18 fluorodeoxyglucose PET/CT patterns of extranodal
involvement in patients with Non-Hodgkin lymphoma and Hodgkin's disease.
Even-Sapir E, Lievshitz G, Perry C, Herishanu Y, Lerman H, Metser U.
Radiol Clin North Am. 2007 Jul;45(4):697-709
2. PET and PET/CT in management of the lymphomas. Podoloff DA,
Macapinlac HA. Radiol Clin North Am. 2007 Jul;45(4):689-96.
3. Normal and abnormal patterns of 18F-fluorodeoxyglucose PET/CT in
lymphoma. Bar-Shalom R. Radiol Clin North Am. 2007 Jul;45(4):677-88
This case was compiled by Dr. Sania Rahim-Gilani and Dr. David He, BCM
involvement in patients with Non-Hodgkin lymphoma and Hodgkin's disease.
Even-Sapir E, Lievshitz G, Perry C, Herishanu Y, Lerman H, Metser U.
Radiol Clin North Am. 2007 Jul;45(4):697-709
2. PET and PET/CT in management of the lymphomas. Podoloff DA,
Macapinlac HA. Radiol Clin North Am. 2007 Jul;45(4):689-96.
3. Normal and abnormal patterns of 18F-fluorodeoxyglucose PET/CT in
lymphoma. Bar-Shalom R. Radiol Clin North Am. 2007 Jul;45(4):677-88
This case was compiled by Dr. Sania Rahim-Gilani and Dr. David He, BCM
Patient was treated with R-CVP (rituximab, cyclophosphamide, vincrisine
and prednisone) with adriamycin added in the second cycle. PET-CT
obtained post 2 cycles of chemotherpy showed complete resolution of all
hypermetabolic lesions, suggesting good response to therapy.
and prednisone) with adriamycin added in the second cycle. PET-CT
obtained post 2 cycles of chemotherpy showed complete resolution of all
hypermetabolic lesions, suggesting good response to therapy.