Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Early detection of intravascular large B-cell lymphoma by 18FDG-PET/CT with diffuse FDG uptake in the lung without respiratory symptoms or chest CT abnormalities

Document Type : Case report

Authors
Masato Shiiba 1
Koji Izutsu 2
Makiko Ishihara 1
1 Department of Diagnostic Imaging Center, Toranomon Hospital, Tokyo, Japan
2 Department of Hematology, Toranomon Hospital, Tokyo, Japan
10.7508/aojnmb.2014.01.009
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of systemic extranodal non-Hodgkin diffuse large B-cell lymphoma (DLBCL). We report a rare case of IVLBCL who showed diffuse 18F-fluorodeoxyglucose (FDG) uptake in the lung in FDG-positron emission tomography/computed tomography (PET/CT) without respiratory symptoms or chest CT abnormalities. Serum biochemical studies showed a raised level of lactate dehydrogenase (LDH) and serum soluble interleukin-2 receptor (sIL-2R), which suggested the presence of malignant lymphoma strongly. A non-contrast CT showed no abnormalities in the lung fields, no lymphadenopathy was found. PET/CTFDG- revealed diffuse FDG uptake in the both lungs and in spleen as well as multiple hot spots in the liver. Under the suspicion of IVLBCL especially by the diffuse FDG uptake in the lung, a random skin biopsy was performed from three regions, the left forearm, right abdomen and left thigh in which there had been no evidence of FDG uptake. The definite diagnosis of IVLBCL was made based on the pathological analysis of the specimen from the left thigh. She achieved complete remission (CR) after combined chemoimmunotherapy. FDG-PET/CT was useful for the early detection of IVLBCL even without respiratory symptoms or any abnormal findings by chest CT.
Keywords
IVLBCL
Intravascular large B-cell lymphoma
FDG-PET
Diffuse lung uptake
  1. Orwat DE, Batalis NI. Intravascular large B-cell lymphoma. Arch Pathol Lab Med. 2012; 136(3): 333-8.
  2. Masaki Y, Dong L, Nakajima A, Iwao H, Miki M, Kurose N, et al. Intravascular large B cell lymphoma: proposed of the strategy for early diagnosis and treatment of patients with rapid deteriorating condition. Int J Hematol.2009; 89(5):600-10. 
  3. Shimada K, Kinoshita T, Naoe T, Nakamura S. Presentation and management of intravascular large B-cell lymphoma. Lancet Oncol. 2009;10(9):895-902.
  4. Joshi PV, Lele VR, Shaikh I. Mortui vivos docent--the dead teach the living: 18-flurodeoxyglocose positron emission tomography-computed tomography findings in a case of intravascular B cell lymphoma. J Cancer Res Ther. 2013;9(1):141-4.
  5. Kitanaka A, Kubota Y, Imataki O, Ohnishi H, Fukumoto T, Kurokohchi K, et al. Intravascular large B-cell lymphoma with FDG accumulation in the lung lacking CT/(67)gallium scintigraphy abnormality. Hematol Oncol. 2009;27(1):46-9.
  6. Kohan AA, Paganini L, Biedak P, Arma JI, Dalurzo MC, Garcia-Monaco RD. Pulmonary intravascular lymphoma detected by FDG PET-CT: a case report. Rev Esp Med Nucl Imagen Mol. 2013; 32(5):318-20.
  7. Kotake T, Kosugi S, Takimoto T, Nakata S, Shiga J, Nagate Y, et al. Intravascular large B-cell lymphoma presenting pulmonary arterial hypertension as an initial manifestation. Intern Med. 2010; 49(1):51-4.
  8. Miura Y, Tsudo M. Fluorodeoxyglucose-PET/CT for diagnosis of intravascular large B-cell lymphoma. Mayo Clin Proc. 2010; 85(8):e56-7.
  9. Wagner T, Brechemier D, Dugert E, Le Guellec S, Julian A, Hitzel A, et al. Diffuse pulmonary uptake on FDG-PET with normal CT diagnosed as intravascular large B-cell lymphoma: a case report and a discussion of the causes of diffuse FDG uptake in the lungs. Cancer Imaging. 2012; 12:7-12.
  10. Yamashita H, Suzuki A, Takahashi Y, Kubota K, Kano T, Mimori A. Intravascular large B-cell lymphoma with diffuse FDG uptake in the lung by 18FDG-PET/CT without chest CT findings. Ann Nucl Med. 2012;26(6):515-21.
  11. Boslooper K, Dijkhuizen D, van der Velden AW, Dal M, Meilof JF, Hoogenberg K. Intravascular lymphoma as an unusual cause of multifocal cerebral infarctions discovered on FDG-PET/CT. Neth J Med. 2010; 68(6):261-4.
  12. Hemmaway CJ, Danga A, Igbokwe U, Radunovic A. FDG-PET guided diagnosis of vaginal intravascular diffuse large B-cell lymphoma. Br J Haematol. 2012;158(6):678.
  13. Hoshino A, Kawada E, Ukita T, Itoh K, Sakamoto H, Fujita K, et al. Usefulness of FDG-PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin. Am J Hematol. 2004;76(3):236-9.
  14. Lannoo L, Smets S, Steenkiste E, Delforge M, Moerman P, Stroobants S, et al. Intravascular large B-cell lymphoma of the uterus presenting as fever of unknown origin (FUO) and revealed by FDG-PET. Acta Clin Belg. 2007;62(3):187-90.
  15. Nakazato T, Sanada Y, Mihara A, Ito C, Aisa Y, Nakamura N. PET-negative pulmonary intravascular large B cell lymphoma diagnosed by a random transbronchial lung biopsy. Ann Hematol. 2012;91(5):811-2.
  16. Sanli Y, Turkmen C, Saka B, Kilicaslan I, Dogan O, Erten N, et al. 18F-FDG PET/CT in a case of intravascular large B-cell lymphoma. Eur J Nucl Med Mol Imaging. 2010;37(9):1801.
  17. Takahashi T, Minato M, Tsukuda H, Yoshimoto M, Tsujisaki M. Successful treatment of intravascular large B-cell lymphoma diagnosed by bone marrow biopsy and FDG-PET scan. Intern Med. 2008;47(10):975-9.
  18. Takeoka Y, Inaba A, Fujitani Y, Kosaka S, Yamamura R, Senzaki H, et al. Intravascular large B-cell lymphoma diagnosed by FDG-PET/CT and endometrial biopsy. Rinsho Ketsueki. 2011;52(11):1777-81.
  19. Shimada K, Kosugi H, Shimada S, Narimatsu H, Koyama Y, Suzuki N, et al. Evaluation of organ involvement in intravascular large B-cell lymphoma by 18F-fluorodeoxyglucose positron emission tomography. Int J Hematol. 2008; 88(2):149-53.
  20. Asada N, Odawara J, Kimura S, Aoki T, Yamakura M, Takeuchi M, et al. Use of random skin biopsy for diagnosis of intravascular large B-cell lymphoma. Mayo Clin Proc. 2007; 82(12):1525-7.