Extensive Extranodal Involvement in a case of Non-Hodgkin's Lymphoma with sparing of lymph nodes and lymphatic organs

Document Type : Case report

Authors

Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh India

Abstract

Non-Hodgkin lymphoma (NHL) is a group of malignant lymphoproliferative disorders arising predominantly in the lymph nodes with various clinical and histological characteristics. At least 25% of NHL originates from tissues other than lymph nodes and sometimes even from sites that do not contain lymphoid tissue. These are referred to as primary extranodal lymphomas (pENLs). pENL is a universal diagnostic challenge to the clinicians and pathologists due to their varied clinical presentations, morphological mimicry, and molecular alterations. The GIT is the most common site of pENL followed by nasopharynx/oropharynx, testis, uterus/ovary, thyroid, and central nervous system. Long bones (tibia), maxillary sinus, skin, and paraspinal soft tissues are the other rare anatomic sites of pENL. We reported a case of a 60-year-old female presented with pain and mass in the pelvis region. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and fused PET/CT was done, which revealed extensive extranodal involvement of the lung, bilateral kidneys, uterus, ovaries, bones, and muscles with no involvement of lymph nodes or lymphomatous organs. Extensive extranodal involvement with sparing of lymphomatous organ has not been reported earlier.

Keywords

References

1. Longo D. Malignancies of Lymphoid Cells. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine [Internet]. 19thed. New York, NY: McGraw-Hill Education; 2014 [cited 2020 Apr 7]. Available from: access medicine.mh medical.com/content.aspx? aid= 1138007031
2. Pai A, Kannan T, Balambika R, Vasini V. A Study of Clinical Profile of Primary Extranodal Lymphomas in a Tertiary Care Institute in South India. Indian J Med Paediatr Oncol Off J Indian Soc Med Paediatr Oncol. 2017; 38(3):251–5 .
3. Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, et al. Role of Imaging in the Staging and Response Assessment of Lymphoma: Consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol. 2014 Sep 20; 32(27):3048–58 .
4. Ömür Ö, Baran Y, Oral A, Ceylan Y. Fluorine-18 fluorodeoxyglucose PET-CT for extranodal staging of non-Hodgkin and Hodgkin lymphoma. Diagn Interv Radiol Ank Turk. 2014 Apr; 20(2):185–92 .
5. Schöder H, Polley M-YC, Knopp MV, Hall N, Kostakoglu L, Zhang J, et al. Prognostic value of interim FDG-PET in diffuse large cell lymphoma: results from the CALGB 50303 Clinical Trial. Blood. 2020 Jun 18; 135(25): 2224–34 .
6. Economopoulos T, Asprou N, Stathakis N, Papageorgiou E, Dervenoulas J, Xanthaki K, et al. Primary Extranodal Non-Hodgkin’s Lymphoma in Adults: Clinicopathological and Survival Characteristics. Leuk Lymphoma. 1996 Jan; 21(1–2):131–6 .
7. la Fougère C, Hundt W, Bröckel N, Pfluger T, Haug A, Scher B, et al. Value of PET/CT versus PET and CT performed as separate investigations in patients with Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging. 2006 Dec; 33(12): 1417–25 .
8. El-Sharkawy MS, Siddiqui N, Aleem A, Diab AA. Renal involvement in lymphoma: prevalence and various patterns of involvement on abdominal CT.Int Urol Nephrol. 2007; 39(3):929–33 .
9. Sheth S, Ali S, Fishman E. Imaging of Renal Lymphoma: Patterns of Disease with Pathologic Correlation. RadioGraphics. 2006 Jul 1; 26(4):1151–68 .
10. Nicolau C, Sala E, Kumar A, Goldman DA, Schoder H, Hricak H, et al. Renal Masses Detected on FDG PET/CT in Patients With Lymphoma: Imaging Features Differentiating Primary Renal Cell Carcinomas From Renal Lymphomatous Involvement. AJR Am J Roentgenol. 2017 Apr; 208(4):849–53 .
11. Kim JH, Lee S-H, Park J, Kim HY, Lee SI, Park JO, et al. Primary pulmonary non-Hodgkin’s lymphoma. Jpn J Clin Oncol. 2004 Sep; 34(9):510–4 .
12. Ilica AT, Kocacelebi K, Savas R, Ayan A. Imaging of Extranodal Lymphoma With PET/CT. Clin Nucl Med. 2011 Oct; 36 (10): e127 .
13. Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of Extranodal Involvement in Non-Hodgkin Lymphoma and Hodgkin Disease. RadioGraphics. 2010 Jan 1; 30(1):269–91 .
14. Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, et al. Primary lymphomas of the cervix and uterus: The University of Pennsylvania’s experience and a review of the literature. Leuk Lymphoma. 2006 Jan 1; 47(9):1894–901 .
15. Kitajima K, Murakami K, Kaji Y, Sugimura K. Spectrum of FDG PET/CT Findings of Uterine Tumors. Am J Roentgenol. 2010 Sep 1; 195(3):737–43 .
16. Hu R, Miao M, Zhang R, Li Y, Li J, Zhu K, et al. Ovary involvement of diffuse large B-cell lymphoma. Am J Case Rep. 2012 Jun 5; 13:96–8 .
17. Hukuimwe M, Ziruma A, Gidiri MF, Manase M. Large B cell lymphoma presenting as an adnexal mass in an HIV positive patient: a case report. Pan Afr Med J [Internet]. 2019 Jul 8 [cited 2020 Aug 11]; 33(290). Available from: https://www.panafrican-med-journal.com/ content/article/33/290/full/#ref1
18. Chong J, Som PM, Silvers AR, Dalton JF. Extranodal non-Hodgkin lymphoma involving the muscles of mastication. Am J Neuroradiol. 1998 Nov 1; 19(10):1849–51 .
19. Chun CW, Jee W-H, Park HJ, Kim YJ, Park J-M, Lee S-H, et al. MRI Features of Skeletal Muscle Lymphoma. Am J Roentgenol. 2010 Dec 1; 195(6):1355–60 .
20. Moog F, Kotzerke J, Reske SN. FDG PET Can Replace Bone Scintigraphy in Primary Staging of Malignant Lymphoma. J Nucl Med. 1999 Sep 1; 40(9):1407–13 .
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 9, Issue 1
January 2021
Pages 39-44

Files

Share

How to cite

Statistics