Incremental Value of FDG PET/CT in Aggressive High Grade B Cell lymphoma with TdT Expression

Document Type : Case report

Authors

1 Department of Nuclear Medicine and PET/CT, Apollo Hospitals, Chennai, India

2 Department of Pathology, Apollo Hospitals, Chennai, India

Abstract

High-grade B-cell lymphoma, an aggressive form of Non-Hodgkin’s Lymphoma, is known as a double or triple hit lymphoma based on the presence of MYC and BCL2 without or with BCL6 genetic rearrangements, respectively. It carries a poorer prognosis, compared to other variants of B-cell lymphoma, and its management also differs which requires more intensive chemotherapy in contrast to the routine regimen. Terminal deoxynucleotidyl transferase (TdT), a marker of immaturity is commonly expressed in B-cell lymphoblastic leukemia or lymphoma (B cell ALL) which is absent in mature forms of B-cell lymphoma. The TdT is expressed in high-grade B-cell lymphoma; therefore, it poses a classification and management dilemma, which should be accurately differentiated from B-cell ALL and mandates molecular analysis. Herein, we report a case of a 52-year-old female with biopsy reported as high-grade B-cell lymphoma with TdT expression. She was referred for Fluor-deoxyglucose (FDG) Positron Emission Tomography-Computed Tomography (PET/CT) scan for staging in the absence of molecular analysis for B-cell ALL. It was diagnosed as lymphoma on FDG PET/CT based on its characteristic findings of extensive extranodal involvement of multiple organs with no significant lymphadenopathy establishing the incremental value of FDG PET/CT scan, which helped the clinician to arrive at a conclusion.

Keywords

Main Subjects


1. 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 journal of medical and paediatric oncology: official journal of Indian Society of Medical & Paediatric Oncology. 2017; 38(3):251.
2. Tashakori M, Crane G.High grade B cell lymphoma with MYC and BCL2 or BCL6 rearrangements.http://www.pathologyoutli nes.com/topic/lymphomabunclassburkitt.ht ml (accessed March 21 2020).
3. Soliman DS, Al-Sabbagh A, Ibrahim F, Taha RY, Nawaz Z, Elkourashy S, et al. High-grade B-cell neoplasm with surface light chain restriction and Tdt coexpression evolved in a MYCrearranged diffuse large B-cell lymphoma: a dilemma in classification. Case reports in hematology. Epub 2017 Aug 13
4. Kim D-Y, Park H-S, Choi E-J, Lee J-H, Lee J-H, Jeon M, et al. Immunophenotypic markers in adult acute lymphoblastic leukemia: the prognostic significance of CD20 and TdT expression. Blood research. 2015; 50(4):227- 34.
5. Ok CY, Medeiros LJ, Thakral B, Tang G, Jain N, Jabbour E, et al. High-grade B-cell lymphomas with TdT expression: a diagnostic and classification dilemma. Modern Pathology. 2019; 32(1):48-58.
6. Steinbacher DM, Dolan RW. Isolated nonHodgkin’s lymphoma of the mandible. Oral Oncology EXTRA. 2006; 42(5):187-9.
7. Sheth S, Ali S, Fishman E. Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics. 2006; 26(4):1151-68.
8. Onyiuke I, Kirby AB, McCarthy S. Primary gynecologic lymphoma: imaging findings. American Journal of Roentgenology. 2013; 201(4):W648-W55.
9. Terwilliger T, Abdul-Hay M. Acute lymphoblastic leukemia: a comprehensive review and 2017 update. Blood cancer journal. 2017; 7(6):e577-e.
10. Oh M-Y, Oh S-B, Seoung H-G, Kim J-H, Kim SM, Kim T-K, et al. Clinical significance of standardized uptake value and maximum tumor diameter in patients with primary extranodal diffuse large B cell lymphoma. The Korean journal of hematology. 2012; 47(3):207-12.