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Rare skin and testicular extranodal involvement in a patient with marginal zone lymphoma on 18F-FDG PET-CT imaging

Pelin Ozcan Kara

Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Zehra Pinar Koc

Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey

Emel Sezer

Mersin University, Faculty of Medicine, Department of Oncology, Mersin, Turkey

Kadir Eser

Mersin University, Faculty of Medicine, Department of Oncology, Mersin, Turkey

DOI: 10.15761/NMBI.1000124

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Abstract

Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL) are the malignant neoplasm spectrum originating from the lymphoid system and constituting 8% of all malignancies. Although, both are known as primary malignancies of lymph nodes, extranodal involvement can be seen. In this case presentation, in addition to nodal and bone involvement areas in a patient diagnosed as marginal zone lymphoma, rare simultaneous testicular and skin extranodal involvement detected on 18F-FDG PET-CT imaging were presented.

Key words

rare skin, testicular extranodal, PET-CT imaging, marginal zone lymphoma, nuclear medicine, Hodgkin lymphoma, Non-Hodgkin lymphoma

Abbreviations:

Hodgkin lymphoma-HL, Non-Hodgkin lymphoma-NHL, Marginal zone lymphomas-MZL

Introduction

Extranodal involvement areas such as gastrointestinal, head and neck, orbital, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid and genitourinary system can be seen in 25-40% of HL and especially NHL patients, although it is known as lymph node malignancy [1,2]. Extranodal involvement is important in terms of prognosis and imaging procedures play a very important role in diagnosis. 18F-FDG PET-CT imaging is a standard method in lymphoma patients and has a special importance in these patients in terms of superiority of CT imaging in detecting extranodal regions. The role of 18F-FDG PET-CT in detection, staging and restaging of patients with extranodal involvement in NHL has also been reported in the literature [3,4]. In this case presentation, in addition to nodal and bone involvement areas in a patient diagnosed as marginal zone lymphoma, rare testicular and skin extranodal simultaneous involvement detected on 18F-FDG PET-CT imaging were presented.

Case report

A 72-year-old male patient diagnosed as marginal zone lymphoma following mass excision from the left thoracic cage underwent 18F-FDG PET-CT imaging for initial staging. PET-CT images showed hypermetabolic (SUVmax: 14.66-31.89) conglomereted  lymphadenopathies in the bilateral cervical chain, supraclavicular area, bilateral axillary, mediastinal, retroperitoneal, paraaortic, peripancreatic, perigastric, liver hilum, paracoeliac regions, pericardial thickening-effusion and hypermetabolic (SUVmax: 3.32-12.83) bone lesions. Additionally, multiple subcutaneous hypermetabolic (SUVmax: 10.5-24.37) nodules were detected at various levels within the cross-sectional area. In addition; Testis lymphoma FDG uptake (SUVmax: 20.26) was noted in the right hemiscrotum (Figure 1). Testis lymphoma has been proved by excisional biopsy.

Figure 1. 18F-FDG PET-CT Image showing the spread of Lymphoma.

Discussion

Marginal zone lymphomas (MZL) are defined as a heterogeneous group of lymphomas although, can originate from the spleen, lymph nodes and extra-nodal lymphoid tissue, termed as "marginal zone" and formed of B-lymphocytes. Testicular involvement is a very rare entity. Testicular lymphoma can be primary or secondary to extensive disease. Inguinal and retroperitoneal lymph nodal spread can also be seen in some patients [3]. In our case, there was abnormally increased asymmetric FDG uptake in the enlarged right testis. Also, multiple para-aortic lymph nodes showed abnormal FDG accumulation, as if spreading from involved testis by lymphomatous way. Yin et al. reported a case of a 55-year-old man with NHL of the left testis and of the bilateral adrenals detected by 18F-FDG PET-CT and demonstrated its role in the diagnosis and assessment of therapeutic response [5]. Multiple isolated cases with extranodal involvement of NHL, detected on PET-CT, have been previously reported [5-8]. In this case report, in addition to nodal involvement areas in a patient diagnosed as marginal zone lymphoma, rare areas of testicular and skin extranodal involvement detected by 18F-FDG PET-CT imaging is presented. Patients with abnormal testicular involvement should undergo further examination and confirmation of the finding is necessary.

References

  1. Lopez-Guillermo A, Colomo L, Jimenez M, Bosch F, Villamor N, et al. (2005) Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin. J Clin Oncol 23: 2797-804. [Crossref]
  2. Economopoulos T, Papageorgiou S, Rontogianni D, Kaloutsi V, Fountzilas G, et al. (2005) Multifocal Extranodal Non-Hodgkin Lymphoma: a clinicopathologic study of 37 Cases in Greece, a Hellenic Cooperative Oncology Group Study. Oncologist 10: 734-8. [Crossref]
  3. Paes FM, Kalkanis DG, Sideras PA, Serafini AN. (2010) FDG PET/CT of Extranodal Involvement in Non-Hodgkin Lymphoma and Hodgkin Disease. RadioGraphics 30: 269-291.
  4. Even-Sapir E, Lievshitz G, Perry C, Herishanu Y, Lerman H, et al. (2007) Fluorine-18 Fluorodeoxyglucose PET/CT Patterns of Extranodal Involvement in Patients with Non-Hodgkin Lymphoma and Hodgkin’s Disease. Radiol Clin N Am 45: 697-709. [Crossref]
  5. Yin Y, Qing F, Li X, Du B, Li N, et al. (2011) Non-Hodgkin’s lymphoma of the testicle and bilateral adrenals detected by 18F-FDG PET/CT. Exp Theor Med 2: 817-820. [Crossref]
  6. Julian A, Wagner T, Ysebaert L, Chabbert V, Payoux P. (2011) FDG PET/CT leads to the detection of metastatic involvement of the heart in non-Hodgkin’slymphoma. Eur J Nucl Med Mol Imaging 38: 1174.
  7. Kaderli AA, Baran I, Aydin O, Bicer M, Akpinar T, et al. (2010) Diffuse involvement of the heart and great vessels in primary cardiac lymphoma. Eur J Echocardiogr 11: 74-76.
  8. Su HY, Huang HL, Sun CM, Hou SM, Chen ML (2009) Primary cardiac lymphoma evaluated with integration of PET/CT and contrast-enhanced CT. Clin Nucl Med 34: 298-301. [Crossref]

Editorial Information

Editor-in-Chief

Asif Bashir
JFK New Jersey Neuroscience Institute

Article Type

Case Report

Publication history

Received date: Jun 19, 2017
Accepted date: June 29 2017
Published date: June 30 2017

Copyright

© 2017 Pelin Ozcan Kara. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Pelin Ozcan Kara (2017) Rare Skin and Testicular Extranodal Involvement in a Patient with Marginal Zone Lymphoma on 18F-FDG PET-CT Imaging. Nucl Med Biomed Imag 1: DOI: 10.15761/NMBI.1000124

Corresponding author

Pelin Ozcan Kara

Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey, Tel +90 324 241 50 00.

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Figure 1. 18F-FDG PET-CT Image showing the spread of Lymphoma.