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LETTER TO THE EDITOR
Year : 2017  |  Volume : 32  |  Issue : 3  |  Page : 249-250  

Lymphomatous involvement of male breast in a patient with bilateral gynecomastia: Demonstration with 18F-Fluorodeoxyglucose positron emission tomography-computed tomography


Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India

Date of Web Publication13-Jun-2017

Correspondence Address:
Punit Sharma
Department of Nuclear Medicine and Positron Emission Tomography/Computed Tomography, Apollo Gleneagles Hospitals, 13, Canal Circular Road, Kolkata - 700 054, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_35_17

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How to cite this article:
Sharma P. Lymphomatous involvement of male breast in a patient with bilateral gynecomastia: Demonstration with 18F-Fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med 2017;32:249-50

How to cite this URL:
Sharma P. Lymphomatous involvement of male breast in a patient with bilateral gynecomastia: Demonstration with 18F-Fluorodeoxyglucose positron emission tomography-computed tomography. Indian J Nucl Med [serial online] 2017 [cited 2017 Jun 24];32:249-50. Available from: http://www.ijnm.in/text.asp?2017/32/3/249/207886

Sir,

18 F-fluorodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET-CT) has now become the imaging modality of choice for high-grade lymphomas. Being a highly sensitive whole-body metabolic imaging technique, it can demonstrate unusual sites of involvement in these patients, which could be otherwise missed. We present such a case here. A 65-year-old male presented with cervical lymphadenopathy along with progressive weakness, weight loss, and fatigue. Biopsy from the cervical node confirmed diffuse large B-cell lymphoma (DLBCL). A staging contrast-enhanced 18 F-FDG PET-CT was performed.18 F-FDG PET-CT [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e showed lymph nodal involvement on both sides of diaphragm along with splenic involvement. Also noted was hypermetabolic right breast nodule suggesting involvement [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e, bold arrow]. Maximum standardized uptake value of this lesion was 6.2. Based on 18 F-FDG PET-CT findings, a diagnosis of stage IVBE DLBCL was made. A clinical examination was done thereafter which revealed bilateral age-related gynecomastia, firmer and slightly tender on right side, further supporting the diagnosis. The patient was started on rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone chemotherapy but was lost to follow-up after two cycles.
Figure 1: Maximum intensity projection PET image (a) showing hypermetabolic lymphadenopathy both above and below the diaphragm (broken arrows), along with hypermetabolic splenomegaly (arrowhead). Also noted was focal 18-FDG uptake in right anterior chest wall (bold arrow). Transaxial and sagittal CT and PET-CT (b-e) images of the thorax showing focal hypermetabolism involving right breast nodule measuring 17 mm × 15 mm, suggesting involvement (bold arrow). 18F-FDG PET-CT: 18F-fluorodeoxyglucose positron emission tomography-computed tomography

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Breast involvement in lymphoma could be either primary or secondary with latter being more common.[1] Lymphoma accounts for <0.5% of all breast malignancies. Hence, lymphoma of male breast is even rarer.[2] In these patients, it can present with gynecomastia.[3] DLBCL is the most common histopathological subtype.[4] Management is with chemotherapy and adjuvant radiotherapy when required while surgery has no definite role.[5] As for lymphoma of other sites,18 F-FDG PET-CT plays an important role in the management of primary and secondary breast lymphoma.[6],[7] In the present case, while the patient had bilateral gynecomastia clinically, lymphomatous involvement was only seen in right breast. This case reiterates the importance of 18 F-FDG PET-CT in the management of patients with high-grade lymphoma by demonstrating usual sites of involvement.

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There are no conflicts of interest.



 
   References Top

1.
Nicholson BT, Bhatti RM, Glassman L. Extranodal lymphoma of the breast. Radiol Clin North Am 2016;54:711-26.  Back to cited text no. 1
    
2.
Duman BB, Sahin B, Güvenç B, Ergin M. Lymphoma of the breast in a male patient. Med Oncol 2011;28 Suppl 1:S490-3.  Back to cited text no. 2
    
3.
Mukhtar R, Mateen A, Rakha A, Khattak R, Maqsood F. Breast lymphoma presenting as gynecomastia in male patient. Breast J 2013;19:439-40.  Back to cited text no. 3
    
4.
Bano R, Zafar W, Khan AI, Fiaz SA, Abid M, Chaudhary MZ, et al. Breast lymphoma treatment outcomes in a Pakistani population: 20 years of experience at a single center. Asian Pac J Cancer Prev 2016;17:3631-5.  Back to cited text no. 4
    
5.
Niitsu N, Okamoto M, Nakamine H, Hirano M. Clinicopathologic features and treatment outcome of primary breast diffuse large B-cell lymphoma. Leuk Res 2008;32:1837-41.  Back to cited text no. 5
    
6.
Ginat DT, Puri S. FDG PET/CT manifestations of hematopoietic malignancies of the breast. Acad Radiol 2010;17:1026-30.  Back to cited text no. 6
    
7.
Santra A, Kumar R, Reddy R, Halanaik D, Kumar R, Bal CS, et al. FDG PET-CT in the management of primary breast lymphoma. Clin Nucl Med 2009;34:848-53.  Back to cited text no. 7
    


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