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INTERESTING IMAGE
Year : 2020  |  Volume : 35  |  Issue : 1  |  Page : 80-81  

F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of severe primary lung lymphoma


1 Department of Nuclear Medicine, Medical Faculty, Mersin University, Mersin, Turkey
2 Department of Respiratory Medicine, Medical Faculty, Mersin University, Mersin, Turkey
3 Department of Pathology, Medical Faculty, Mersin University, Mersin, Turkey

Date of Submission10-Mar-2019
Date of Acceptance28-Apr-2019
Date of Web Publication31-Dec-2019

Correspondence Address:
Dr. Zehra Pinar Koc
Department of Nuclear Medicine, Mersin University Hospital, Yenisehir, Mersin
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_61_19

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   Abstract 


Primary lung lymphoma is one of the rarest forms of lymphoma and pulmonary space-occupying lesions. This case report represents the F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of the most severe form of the primary pulmonary lymphoma reported in the literature.

Keywords: Fluorodeoxyglucose, lung lymphoma, positron emission tomography/computed tomography


How to cite this article:
Koc ZP, Kara P&, Özge C, Yaldız M. F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of severe primary lung lymphoma. Indian J Nucl Med 2020;35:80-1

How to cite this URL:
Koc ZP, Kara P&, Özge C, Yaldız M. F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of severe primary lung lymphoma. Indian J Nucl Med [serial online] 2020 [cited 2020 Jan 26];35:80-1. Available from: http://www.ijnm.in/text.asp?2020/35/1/80/274377



Primary lung lymphoma is an extremely rare diagnosis presented in only 10% of the non-Hodgkin's lymphoma and 0.4% of all lymphomas.[1] The most effective imaging modality in the staging of lymphoma is accepted to be the F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT). The definition of primary lung lymphoma includes sole involvement of the lung parenchyma with or without mediastinal lymph nodes but necessarily not distant involvement.[2] Usually, mucosa-associated lymphoid tissue (MALT) type is associated with primary lung lymphoma, but diffuse large B-cell lymphoma subtype has also been reported.[3] A recent case report showed primary pulmonary lymphoma with F-18 FDG PET/magnetic resonance (MR) images involving single lobe.[4] This case presentation shows the most severe involvement of the lungs in the literature with F-18 FDG PET/CT images.

A 47-year-old man with the anamnesis of dyspnea attended the hospital. The patient had severe parenchymal disease with suspicious pathology result of lymphoma. The F-18 FDG PET/CT imaging was planned in the patient to determine the lymphoma and to find out another biopsy site. The PET/CT imaging was performed by administration of 8.8 mCi FDG via venous line in the state of fasting for 14 h and the blood glucose level of 108 mg/dl. The imaging was performed in craniocaudal direction in three-dimensional acquisition mode for 1 min per bed position with nondiagnostic CT scan for attenuation correction and oral contrast administration. The F-18 FDG PET/CT images demonstrated nothing but severe involvement of both lungs with significant FDG accumulation in the lesions (maximum standardized uptake value of 6.6). [Figure 1] and the pathology results verified the diagnosis of primary lung B cell MALT lymphoma [Figure 2].{Figure 1}
Figure 1:(a) Maximum intensity projection images of fluorodeoxyglucose positron emission tomography/computed tomography showing increased accumulation of activity in both lungs. (b) Cross-sectional transaxial images of both lungs in lung parenchyma window level demonstrating severe hypermetabolic lesions in both lungs. (c) The improvement of the lesions in both lungs are observed in the corresponding slice in the 2-month follow-up

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The lung parenchyma findings are not specific for lymphoma, thus should be differentiated from malignant primary lung diseases. In case of nodal involvement, lymph node biopsy could be considered for the diagnosis of lymphoma. MALT type has indolent disease course with spontaneous regression; however, diffuse B-cell type is an aggressive form.[5] The primary lung lymphoma might be presented with single parenchyma opacity and focus with significant FDG uptake[6] or infiltrative parenchyma disease as in the presented case. To provide a diagnosis of primary lung lymphoma, the disease has to be limited to the thorax at the time of diagnosis and 3-month follow-up.[7],[8] This case report shows atypical severe parenchyma involvement of MALT type B-cell lymphoma with any nodal involvement in the F-18 FDG PET/CT.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Zinzani PL, Martelli M, Poletti V, Vitolo U, Gobbi PG, Chisesi T, et al. Practice guidelines for the management of extranodal non-Hodgkin's lymphomas of adult non-immunodeficient patients. Part I: Primary lung and mediastinal lymphomas. A project of the İtalian Society of Hematology, the İtalian Society of Experimental Hematology and the İtalian Group for Bone Marrow Transplantation. Haematologica 2008;93:1364-71.  Back to cited text no. 1
    
2.
Cooksley N, Judge DJ, Brown J. Primary pulmonary Hodgkin's lymphoma and a review of the literature since 2006. BMJ Case Rep 2014;2014. pii: bcr2014204020.  Back to cited text no. 2
    
3.
Wróbel T, Dzietczenia J, Prochorec-Sobieszek M, Mazur G, Piwkowski P. Primary pulmonary diffuse large B-cell lymphoma. Am J Hematol 2012;87:107-8.  Back to cited text no. 3
    
4.
Xu H, Xu K, Wang R, Liu X. Primary pulmonary diffuse large B-cell lymphoma on FDG PET/CT-MRI and DWI. Medicine (Baltimore) 2015;94:e1210.  Back to cited text no. 4
    
5.
Zhu Z, Liu W, Mamlouk O, O'Donnell JE, Sen D, Avezbakiyev B. Primary pulmonary diffuse large B cell non-Hodgkin's lymphoma: A case report and literature review. Am J Case Rep 2017;18:286-90.  Back to cited text no. 5
    
6.
Yoshino N, Hirata T, Takeuchi C, Usuda J, Hosone M. A case of primary pulmonary diffuse large B-cell lymphoma diagnosed by transbronchial biopsy. Ann Thorac Cardiovasc Surg 2015;21:396-8.  Back to cited text no. 6
    
7.
Graham BB, Mathisen DJ, Mark EJ, Takvorian RW. Primary pulmonary lymphoma. Ann Thorac Surg 2005;80:1248-53.  Back to cited text no. 7
    
8.
Vanden Eynden F, Fadel E, de Perrot M, de Montpreville V, Mussot S, Dartevelle P. Role of surgery in the treatment of primary pulmonary B-cell lymphoma. Ann Thorac Surg 2007;83:236-40.  Back to cited text no. 8
    


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  [Figure 2], [Figure 2]



 

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