Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

18F-FDG PET/CT imaging of IgG4-producing MALT lymphoma with multiple site involvement

Document Type : Case report

Authors
Kodai Kawaji 1
Seiji Kurata 2
Katsuhisa Matsuo 3
Hiroaki Miyoshi 3
Jun Akiba 4
Fumihiko Mouri 5
Akiko Sumi 2
Kiminori Fujimoto 2
Toshi Abe 2
1 Department of Radiology, Kagoshima University, Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
2 Department of Radiology, Kurume University School of Medicine, Kurume, Japan
3 Department of Pathology, Kurume University School of Medicine, Kurume, Japan
4 Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
5 Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Japan
10.22038/aojnmb.2023.73477.1512
Abstract
18F-FDG PET/CT is regarded as a modality utilized for the purpose of lesion localization, staging and assessment of treatment response in patients with lymphoma. However, it is difficult that we diagnose among multifocal lymphoma, IgG4-related disease (IgG4-RD), or a combination of both conditions when confronted with multiple sites of 18F-FDG uptake with heightened serum IgG4 levels.
We present a case of a 72-year-old male who was suspected of Sjögren’s syndrome based on symptoms of xerostomia accompanied by swelling of the bilateral upper eyelid and salivary glands. Following a diagnostic biopsy that revealed mucosa-associated lymphoid tissue (MALT) lymphoma as a possible finding, 18F-FDG PET/CT was conducted, which demonstrated multiple sites of 18F-FDG accumulation. While multifocal MALT lymphoma was initially suspected, the coexistence of IgG4-RD could not be definitively ruled out due to the elevated serum IgG4 levels. Subsequent histopathological and immunohistochemical examinations confirmed the diagnosis of IgG4-producing MALT lymphoma. After receiving systemic therapy with rituximab, the swelling of the bilateral upper eyelid and parotid glands resolved upon visual examination, and the serum IgG4 levels returned to within the normal range in a few months. No new lesions were detected during the subsequent follow-up examinations conducted over a period of 3 years.
Keywords
IgG4-producing MALT lymphoma
IgG4-related disease
18F-FDG PET/CT
Multiple 18F-FDG uptake
Plasmacytic differentiation
Subjects
  1. Thieblemont C, Berger F, Dumontet C, Moullet I, Bouafia F, Felman P, et al. Mucosa-associated lymphoid tissue lymphoma is a disseminated disease in one third of 158 patients analyzed. Blood. 2000; 95(8):802-6.
  2. Tsuboi H, Hagiwara S, Asashima H, Umehara H, Kawakami A, Nakamura H, et al. Validation of different sets of criteria for the diagnosis of Sjögren's syndrome in Japanese patients. Mod Rheumatol. 2013; 23(2):219-25.
  3. Umehara H, Okazaki K, Kawa S, Takahashi H, Goto H, Matsui S, et al. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021; 31(3): 529-33.
  4. Zucca E, Bertoni F. The spectrum of MALT lymphoma at different sites: biological and therapeutic relevance. 2016; 127 (17): 2082-92.
  5. Sumii Y, Asada N, Sato Y, Ohshima K, Makita M, Yoshimoto Y, et al. Treatment outcomes of IgG4-producing marginal zone B-cell lymphoma: a retrospective case series. Int J Hematol. 2020; 112(6):780-6.
  6. Shimokihara K, Kawahara T, Kasahara R, Kasuga J, Sugiura S, Tajiri R, et al. IgG4-Producing MALT Lymphoma in the Renal Hilum. Case Rep Oncol. 2019; 27(3):880-4.
  7. Albano D, Durmo R, Treglia G, Giubbini R, Bertagna F. 18F-FDG PET/CT or PET Role in MALT Lymphoma: An Open Issue not Yet Solved - A Critical Review. Clin Lymphoma Myeloma Leuk. 2020; 20(3):137-46.
  8. Zhang J, Chen H, Ma Y, Xiao Y, Niu N, Lin W, et al. Characterizing IgG4-related disease with 18F-FDG PET/CT: a prospective cohort study. Eur J Nucl Med Mol Imaging. 2014; 41(8):1624-34.
  9. Tang CYL, Chua WM, Cheng LTJ, Fong W, Zaheer S, et al. 18F-FDG PET/CT Mani-festations of IgG4-related Disease. Br J Radiol. 2021; 94(1124):20210105.
  10. Weiler-Sagie M, Bushelev O, Epelbaum R, Dann EJ, Haim N, Avivi I, et al. (18)F-FDG avidity in lymphoma readdressed: A study of 766 patients. J Nucl Med. 2010; 51(1):25-30.
  11. Qi S, Huang MY, Yang Y, Schöder H, Teckie S, Noy A, et al. Uptake of [18F] fluoro-deoxyglucose in initial positron-emission tomography predicts survival in MALT lymphoma. Blood Adv. 2018; 2(6): 649-55.
  12. Wöhrer S, Troch M, Streubel B, Hoffmann M, Müllauer L, Chott A, et al. Pathology and clinical course of MALT lymphoma with plasmacytic differentiation. Ann Oncol. 2007; 18(12):2020-4.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 12, Issue 1
January 2024
Pages 52-56