Rare ocular and skin lesions of Marginal Zone Lymphoma detected by 18F-FDG PET/CT

Document Type : Case Report

Authors

1 Nuclear Medicine Unit, DIM., University of Bari “Aldo Moro”, Bari, Italy

2 Pathological Anatomy Unit, DAP, University of Bari “Aldo Moro”, Bari, Italy

Abstract

We report a case of a 75-year old man that came at hematologist’s attention for lymphoma evaluation due to axillary lymph node enlargement and fever. Thorax, abdomen and pelvis Contrast-Enhanced Computed Tomography (CECT) showed lymph nodes, spleen and liver lesions. Axillary lymph node biopsy was performed and the diagnosis of marginal zone lymphoma (MZL) at stage IV was postulated, then the patient was submitted to chemotherapy (CHT) following the R-CVP scheme. After the end of the eighth cycle of CHT he was submitted to a restaging CECT that showed lymph nodes size reduction in all the sites identified on the staging exam. Furthermore the liver lesions disappeared and spleen lesions size was reduced. A whole-body and head 18F-FDG PET/CT was also performed that showed 18F-FDG uptake lesions in right axillary lymph nodes, spleen and liver and the identification of two more extranodal sites, respectively in conjunctiva and skin. Then the necessity of additional CHT cycles and radiotherapy on extranodal sites was postulated. The patient declined the new therapies and unfortunately succumbed four months later.
In our case whole body and head 18F-FDG-PET/CT, finding two new extranodal lymphomatous sites and confirming the persistence of the disease, refined and guided the management of the patient suggesting the necessity of additional CHT cycles and radiotherapy on extranodal sites.

After histopathological confirmation, a systemic work-up by an oncologist should include whole body and head 18F-FDG-PET/CT to detect possible systemic involvement and guide specific following diagnostic exams.

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Main Subjects

References

Zinzani PL. The many faces of marginal zone lymphoma. Hematology Am Soc Hematol Educ Program. 2012;2012:426-32. 
Deinbeck K, Geinitz H, Haller B, Fakhrian K. Radiotherapy in marginal zone lymphoma. Radiat Oncol. 2013 Jan 2;8:2.
Perry C, Herishanu Y, Metzer U, Bairey O, Ruchlemer R, Trejo L, Naparstek E, Sapir EE, Polliack A. Diagnostic accuracy of PET/CT in patients with extranodal marginal zone MALT lymphoma. Eur J Haematol. 2007 Sep;79(3):205-9.
van den Brand M, van Krieken JH. Recognizing nodal marginal zone lymphoma: recent advances and pitfalls. A systematic review. Haematologica. 2013 Jul;98(7):1003-13.
Reid R1, Friedberg JW. Management of marginal zone lymphoma. Oncology (Williston Park). 2013 Sep;27(9):840, 842, 844.
Rubini G, Altini C, Notaristefano A, Merenda N, Rubini D, Ianora AA, Asabella AN. Role of 18F-FDG PET/CT in diagnosing peritoneal carcinomatosis in the restaging of patient with ovarian cancer as compared to contrast enhanced CT and tumor marker Ca-125. Rev Esp Med Nucl Imagen Mol. 2014 Jan-Feb;33(1):22-7.
Niccoli-Asabella A, Altini C, Notaristefano A, Merenda N, Altieri ML, Stabile-Ianora AA, Fanelli M, Rubini G. A retrospective study comparing contrast-enhanced computed tomography with 18F-FDG-PET/CT in the early follow-up of patients with retroperitoneal sarcomas. Nucl Med Commun. 2013 Jan;34(1):32-9.
Beal KP, Yeung HW, Yahalom J. FDG-PET scanning for detection and staging of extranodal marginal zone lymphomas of the MALT type: a report of 42 cases. Ann Oncol. 2005 Mar;16(3):473-80.
Ferrari C, Minoia C, Asabella AN, Nicoletti A, Altini C, Antonica F, Ficco M, Guarini A, Maggialetti N, Rubini G. Whole body magnetic resonance with diffusion weighted sequence with body signal suppression compared to (18)F-FDG PET/CT in newly diagnosed lymphoma. Hell J Nucl Med. 2014 Jan-Apr;17 Suppl 1:40-9.
Kashyap R, Rai Mittal B, Manohar K, Balasubramanian Harisankar CN, Bhattacharya A, Singh B, Malhotra P, Varma S. Extranodal manifestations of lymphoma on [¹⁸F]FDG-PET/CT: a pictorial essay. Cancer Imaging. 2011 Nov 26;11:166-74.
Stefanovic A, Lossos IS. Extranodal marginal zone lymphoma of the ocular adnexa. Blood. 2009 Jul 16;114(3):501-10.
Vollmer L. The diagnosis and management of ocular lymphoma. Optom Vis Sci. 2013 Feb;90(2):e56-62.
Woolf DK, Ahmed M, Plowman PN. Primary lymphoma of the ocular adnexa (orbital lymphoma) and primary intraocular lymphoma. Clin Oncol (R Coll Radiol). 2012 Jun;24(5):339-44.
Thieblemont C. Clinical presentation and management of marginal zone lymphomas. Hematology Am Soc Hematol Educ Program. 2005:307-13.
Gerami P, Wickless SC, Querfeld C, Rosen ST, Kuzel TM, Guitart J. Cutaneous involvement with marginal zone lymphoma. J Am Acad Dermatol. 2010 Jul;63(1):142-5.
Schöder H, Noy A, Gönen M, Weng L, Green D, Erdi YE, Larson SM, Yeung HW. Intensity of 18fluorodeoxyglucose uptake in positron emission tomography distinguishes between indolent and aggressive non-Hodgkin's lymphoma. J Clin Oncol. 2005 Jul 20;23(21):4643-51.
Valenzuela AA, Allen C, Grimes D, Wong D, Sullivan TJ. Positron emission tomography in the detection and staging of ocular adnexal lymphoproliferative disease. Ophthalmology. 2006 Dec;113(12):2331-7.
Iranian Journal of Nuclear Medicine
Volume 22, Issue 2 - Serial Number 42
Serial number: 42
June 2014
Pages 89-93

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