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INTERESTING IMAGE
Year : 2017  |  Volume : 32  |  Issue : 2  |  Page : 155-156  

Peritoneal super scan on 18F - FDG PET-CT in a patient of burkitt's lymphoma


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication16-Mar-2017

Correspondence Address:
Dr. Shamim Ahmed Shamim
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.202250

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   Abstract 

Peritoneal lymphomatosis is seen less frequently, but when seen, it is mostly associated with aggressive variants of malignancies. FDG uptake has been reported in peritoneal lymphomatosis both in DLBCL and Burkitt's lymphoma. We report a case of Burkitt's lymphoma with involvement of entire peritoneum, which looks like a “peritoneal super scan” on FDG PET-CT.

Keywords: Burkitt's lymphoma, FDG PET-CT, peritoneal lymphomatosis, peritoneal super scan, super scan


How to cite this article:
Roy SG, Parida GK, Tripathy S, Singhal A, Shamim SA, Tripathi M. Peritoneal super scan on 18F - FDG PET-CT in a patient of burkitt's lymphoma. Indian J Nucl Med 2017;32:155-6

How to cite this URL:
Roy SG, Parida GK, Tripathy S, Singhal A, Shamim SA, Tripathi M. Peritoneal super scan on 18F - FDG PET-CT in a patient of burkitt's lymphoma. Indian J Nucl Med [serial online] 2017 [cited 2019 Nov 22];32:155-6. Available from: http://www.ijnm.in/text.asp?2017/32/2/155/202250

A 24-year-old male presented to the Medicine Outpatient Department (OPD) with a chief complaint of progressive abdominal distention since last 2 months. It was associated with dull dragging pain and loss of appetite. With this clinical history, he underwent ultrasonography (USG) of the abdomen as initial evaluation which showed diffuse small bowel wall thickening. A further evaluation with CECT revealed irregular thickening of the peritoneum and omentum. Biopsy from the thickened omentum confirmed the diagnosis of Burkitt's lymphoma. He was then subjected to FDG PET-CT for staging. PET-CT images revealed intense FDG uptake in the entire peritoneum on the maximum intensity projection (MIP) as well as on coronal and sagittal images, with suppressed uptake of the rest of the body including brain and kidneys [Figure 1]A-[Figure 1]B. Fused (PET-CT) images revealed thickening of almost entire peritoneum, omentum, and mesentery with increased FDG uptake [Figure 2]A-[Figure 2]D along with multiple FDG avid marrow lesions involving skull, right humerus, left scapula, multiple bilateral ribs, dorso-lumbar vertebrae [Figure 2]E, [Figure 2]F, sacrum, left acetabulum, and bilateral femoral shaft.
Figure 1: Intense FDG uptake seen in the entire peritoneum on the maximum intensity projection (MIP) as well as on coronal and sagittal images, with suppressed FDG uptake in the rest of the body including brain and kidneys [Figure 1]a-[Figure 1]c, respectively)

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Figure 2: Fused (PET-CT) images reveal thickening of almost entire peritoneum, omentum, and mesentery with increased FDG uptake [Figure 2]a-[Figure 2]d along with multiple FDG avid marrow lesions involving skull, right humerus, left scapula, multiple bilateral ribs, dorso-lumbar vertebrae [Figure 2]e,[Figure 2]f, sacrum, left acetabulum, and bilateral femoral shaft

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Peritoneum is often involved in many malignant conditions.[1],[2] Lymphomatous involvements of peritoneum are seen less frequently; however, most of them are aggressive variants.[1],[2],[3] FDG uptake has been reported in peritoneal lymphomatosis both in DLBCL and Burkitt's lymphoma.[4],[5],[6] Our case illustrates intense FDG uptake involving the entire peritoneum with suppressed FDG activity of the rest of the body including brain and kidneys, giving it an appearance of “super scan.” Skeletal and hepatic super scans have already been mentioned in the literature in lympho-reticular malignancies.[7],[8],[9] To our knowledge, such “peritoneal super scan” has not been reported till date.

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Conflicts of interest

There are no conflicts of interest

 
   References Top

1.
Cabral FC, Krajewski KM, Kim KW, Ramaiya NH, Jagannathan JP. Peritoneal lymphomatosis: CT and PET/CT findings and how to differentiate between carcinomatosis and sarcomatosis. Cancer Imaging 2013;13:162-70.  Back to cited text no. 1
    
2.
Toma P, Granata C, Rossi A, Garaventa A. Multimodality imaging of Hodgkin disease and non-Hodgkin lymphomas in children. Radiographics 2007;27:1335-54.  Back to cited text no. 2
    
3.
Wong S, Sanchez TR, Swischuk LE, Huang FS. Diffuse peritoneal lymphomatosis: atypical presentation of Burkitt lymphoma. Pediatr Radiol 2009;39:274-6.  Back to cited text no. 3
    
4.
Yapar AF, Reyhan M. 18F-FDG uptake in diffuse peritoneal lymphomatosis. Clin Nucl Med 2012;37:e176-7.  Back to cited text no. 4
    
5.
Kaneko K, Masunari S, Yoshida T, Omagari J. FDG-PET/CT findings of peritoneal lymphomatosis. Clin Nucl Med 2012;37:1117-9.  Back to cited text no. 5
    
6.
Jiménez Granero P, García Gómez FJ, Ruiz Mercado M, Borrego Dorado I. 18F-FDG PET/CT in extranodal Burkitt lymphoma. Clin Nucl Med 2015;40:748-9.  Back to cited text no. 6
    
7.
Basu S, Nair N. Unusually elevated liver radioactivity on F-18 FDG PET in Hodgkin's disease: hepatic “superscan.” a Clin Nucl Med 2004;29:626-8.  Back to cited text no. 7
    
8.
Parida GK, Soundararajan R, Passah A, Bal C, Kumar R. Metabolic skeletal superscan on 18F-FDG PET/CT in a case of acute lymphoblastic leukemia. Clin Nucl Med 2015;40:567-8.  Back to cited text no. 8
    
9.
Dae-Weung Kim, Chang Guhn Kim, Soon-Ah Park, Sang-Ah Jung, Sei-Hoon Yang. Metabolic Super Scan in 18F-FDG PET/CT Imaging. J Korean Med Sci 2010;25:1256-257.  Back to cited text no. 9
    


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