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 Table of Contents     
CASE REPORT
Year : 2014  |  Volume : 29  |  Issue : 4  |  Page : 260-261  

18 Fluoride-fluorodeoxyglucose positron emission tomography in initial staging and response assessment of primary non-Hodgkin lymphoma of the tibia


1 Department of Nuclear Medicine and PET CT, Amala Institute of Medical Sciences, Amalanagar, Thrissur, India
2 Department of Radiodiagnosis, Amala Institute of Medical Sciences, Amalanagar, Thrissur, India
3 Department of Medical Oncology, Lakeshore Hospital, Ernakulam, Kerala, India

Date of Web Publication11-Oct-2014

Correspondence Address:
Chidambaram Natrajan Balasubramanian Harisankar
Department of Nuclear Medicine, Amala institute of Medical Sciences, Amalanagar, Thrissur - 680 555, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.142636

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   Abstract 

Primary lymphoma of the bone is a rare clinical presentation constituting to <1% of all lymphomas. The long bones are usually involved. Combined treatment with chemotherapy and radiation offers long-term survival. The authors present the role of 18 fluoride-fluorodeoxyglucose positron emission tomography-computerized tomography in initial staging and response assessment in a case of primary diffuse large B cell lymphoma of the tibia.

Keywords: Diffuse large B-cell lymphoma, fludeoxyglucose positron emission tomography, primary bone lymphoma, response assessment


How to cite this article:
Harisankar CB, John J, Lekshmi TP, Warrier A. 18 Fluoride-fluorodeoxyglucose positron emission tomography in initial staging and response assessment of primary non-Hodgkin lymphoma of the tibia. Indian J Nucl Med 2014;29:260-1

How to cite this URL:
Harisankar CB, John J, Lekshmi TP, Warrier A. 18 Fluoride-fluorodeoxyglucose positron emission tomography in initial staging and response assessment of primary non-Hodgkin lymphoma of the tibia. Indian J Nucl Med [serial online] 2014 [cited 2019 Nov 14];29:260-1. Available from: http://www.ijnm.in/text.asp?2014/29/4/260/142636


   Introduction Top


Primary bone lymphoma is a rare, but distinct clinical entity. Both Hodgkin and non-Hodgkin lymphoma (NHL) can involve the bones. The involvement may be solitary or multi-focal. Patients with primary bone lymphoma usually have a good prognosis. Combined treatment with chemotherapy and radiation has good response with the majority of the low-risk patients surviving until 10 years. We present the role of 18 fluoride-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (18F-FDG PET-CT) in an interesting case of primary diffuse large B cell lymphoma (DLBCL) of the tibia.


   Case report Top


A 53-year-old-male patient who presented with pain and swelling of the right lower limb was evaluated. A biopsy from the swelling revealed DLBCL. He was referred to our center for a whole body 18F-FDG PET-CT for initial staging. Pretreatment 18F-FDG PET-CT of the thigh and leg showed intense metabolic activity in a large soft tissue mass arising from the proximal part of right tibia [Figure 1]. No abnormal metabolic activity was noted in the rest of the body.

The patient underwent chemotherapy and local radiation to the involved site and was referred for an 18F-FDG PET-CT 3 months after the completion of treatment. Posttreatment 18F-FDG PET-CT was normal with complete regression of previously noted abnormality [Figure 2].
Figure 1: Pretreatment 18 fluoride-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) showing intense metabolically active soft tissue lesion noted involving the proximal part of right tibia (coronal PET (a), fused coronal PET CT (b), sagittal PET (d), sagittal fused PET CT (e) and maximum intensity projection (MIP) lower limbs (f)). MIP of the whole body FDG PET (c) showing no abnormal lymph nodes elsewhere in the body

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Figure 2: Posttreatment 18 fl uoride-fl uorodeoxyglucose positron emission tomography-computed tomography (PET-CT) showing complete resolution of metabolic activity in the proximal part of right tibia (coronal PET (a), fused coronal PET CT (b), sagittal PET (d), sagittal fused PET CT (e) and maximum intensity projection (MIP) lower limbs (f)). MIP of the whole body FDG PET (c) showing no abnormal lymph nodes elsewhere in the body. Minimal diffuse FDG uptake in the lower limbs muscles is likely related to local radiotherapy

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   Discussion Top


Extra nodal lymphomas are fairly common. Primary bone lymphomas represent approximately 5% of the extranodal lymphomas, majority of which are DLBCL. [1] Primary bone lymphomas constitute to <1% of all NHL. [2] Primary Hodgkin lymphoma of the bone is extremely rare. [3] Most patients present with localized pain, swelling or pathological fracture. They can arise from any bone, but long bones (femurs and tibiae) are the common sites. 18F-FDG PET CT helps in identification of lymph nodal involvement and also differentiation of monostotic from polyostotic involvement by lymphoma. 18F-FDG PET-CT is beneficial in the response assessment and effectiveness of treatment. Viable tumor lesions are difficult to be differentiate from bone fibrosis and remodeling using conventional modalities. 18F-FDG PET is also more sensitive than magnetic resonance imaging in identifying response. [4] Primary lymphoma involving the bone usually has an excellent prognosis. [5] Patients treated with combined modality versus single modality therapy were found to have a superior outcome, with a significantly better survival. The 5-year overall survival for patients treated with combined modality was 95% in one of the largest studies. [5] Reports on the utility of 18F-FDG PET-CT in primary bone lymphomas have also been published. [6],[7] Role of 18F-FDG PET-CT in initial staging and response assessment in lymphomas has been well-established. [8],[9] This case reports adds to the existing knowledge that 18F-FDG PET-CT is a useful modality in assessment of primary bone lymphoma.

 
   References Top

1.
Mikhaeel NG. Primary bone lymphoma. Clin Oncol (R Coll Radiol) 2012;24:366-70.  Back to cited text no. 1
[PUBMED]    
2.
Kitsoulis P, Vlychou M, Papoudou-Bai A, Karatzias G, Charchanti A, Agnantis NJ, et al. Primary lymphomas of bone. Anticancer Res 2006;26:325-37.  Back to cited text no. 2
    
3.
Oshikawa G, Arai A, Sasaki K, Ichinohasama R, Miura O. Primary multifocal osseous Hodgkin lymphoma. Rinsho Ketsueki 2009;50:92-6.  Back to cited text no. 3
    
4.
Park YH, Kim S, Choi SJ, Ryoo BY, Yang SH, Cheon GJ, et al. Clinical impact of whole-body FDG-PET for evaluation of response and therapeutic decision-making of primary lymphoma of bone. Ann Oncol 2005;16:1401-2.  Back to cited text no. 4
[PUBMED]    
5.
Beal K, Allen L, Yahalom J. Primary bone lymphoma: Treatment results and prognostic factors with long-term follow-up of 82 patients. Cancer 2006;106:2652-6.  Back to cited text no. 5
    
6.
Kalkanis D, Kalkani M, Gomes H, Paes F, Sideras P, Sfakianakis GN. Interesting image. FDG-PET/CT in primary large B-cell lymphoma of the hard palate. Clin Nucl Med 2010;35:24-5.  Back to cited text no. 6
    
7.
Bosch-Barrera J, Arbea L, García-Velloso MJ, Gil-Bazo I, García-Foncillas J, Panizo C. Primary bone lymphoma of the mandible and thyroid incidentaloma identified by FDG PET/CT: A case report. Cases J 2009;2:6384.  Back to cited text no. 7
    
8.
de Geus-Oei LF, Vriens D, Arens AI, Hutchings M, Oyen WJ. FDG-PET/CT based response-adapted treatment. Cancer Imaging 2012;12:324-35.  Back to cited text no. 8
    
9.
Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med 2009;50 Suppl 1:21S-30.  Back to cited text no. 9
    


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