Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Misinterpretation of an inflammatory FDG uptake in a patient treated for Hodgkin lymphoma: a case report

Document Type : Case report

Authors
Alberto Nieri 1
Luca Urso 1, 2
Matteo Caracciolo 1
Maria Ciccone 3
Licia Uccelli 2
Corrado Cittanti 1, 2
Antonio Cuneo 3
Mirco Bartolomei 1
1 Nuclear Medicine Unit, University Hospital of Ferrara, Ferrara, Italy
2 Department of Translational Medicine, University of Ferrara, Ferrara, Italy
3 Hematology Unit, University Hospital of Ferrara, Ferrara, Italy
10.22038/aojnmb.2022.66011.1457
Abstract
Hodgkin Lymphoma (HL) is a malignancy involving lymph nodes and lymphatic system. [18F]F-FDG PET/CT (FDG-PET) imaging is routinely used for staging, to assess early chemotherapy response (interim FDG-PET), at the end of treatment (EoT FDG-PET) and for the identification of disease recurrence.
We present a case of a 39-year-old man treated for HL. FDG-PET scans performed after first line therapy (both Interim PET and at the end of therapy) demonstrated a persistent and significant mediastinal FDG uptake. The patient was treated with a second line therapy but the FDG-PET uptake did not change. After board discussion a new surgical, thoracoscopy-guided biopsy was performed. Histopathology demonstrated a dense fibrous tissue with occasional chronic inflammatory infiltrates.
Persistent FDG-PET positivity may suggest refractory or relapsed disease. However, occasionally, non-malignant conditions are responsible for a persistent FDG uptake, not related to primary disease. An accurate evaluation of clinical history and previous imaging exams is mandatory for clinicians and others experts to avoid misinterpretations of FDG-PET results. Nevertheless, in some cases, only a more invasive procedure, such as a biopsy, may finally lead to a definitive diagnosis.
Keywords
Hodgkin Lymphoma
18F-FDG PET/CT
Therapy response
Pitfall
Biopsy
Subjects
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Asia Oceania Journal of Nuclear Medicine and Biology
Volume 11, Issue 2
July 2023
Pages 171-174