Sharjeel Usmani ( Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khaitan, Kuwait. )
Farah Luai Albader ( Department of Nuclear Medicine , Kuwait Cancer Control Center, Kuwait, )
Fahad Marafi ( Department of Nuclear Medicine, Jaber al-Ahmed Molecular Imaging Center, Khaitan, Kuwait )
Rehab S. Elhaggracy ( Department of Hematology, Kuwait Cancer Control Center, Kuwait, )
18F-Fluorodeoxyglucose (FDG) PET-CT is an excellent imaging modality for the evaluation of non-Hodgkin lymphoma (NHL). We report a case of a 45-year-old woman presented with a large right breast mass and suspicious right axillary lymph nodes referred for 18F-FDG PET-CT for staging. 18F-FDG PET-CT images show large hypermetabolic right breast mass infiltrating the skin, multiple hypermetabolic right axillary and subpectoral lymph nodes, along with multiple hypermetabolic bone lesions at axial and appendicular skeleton. Findings are mimicking primary breast cancer with nodal and bone metastases. Biopsy revealed diffuse large B cell lymphoma. 18F-FDG PETCT is helpful in evaluation of disease extent and response evaluation of primary breast lymphoma.
Keywords: 18F-FDG PET-CT, Primary breast lymphoma, Diffuse Large B-Cell Lymphoma, PET/CT.
A-45-year-old female presented with right breast mass and enlarged right axillary lymph nodes. Mammography and breast ultrasonography showed BIRAD IV lesion and suspicious right axillary lymph nodes. 18F-FDG PET-CT is performed for staging. 18F-FDG PET/CT images demonstrated large hypermetabolic right breast mass infiltrating the skin. Multiple hypermetabolic right axillary and subpectoral lymph nodes along with multiple hypermetabolic bone lesions were seen at axial and appendicular skeleton. Findings were mimicking primary breast cancer with nodal and bone metastases. Biopsy of the right breast lesion showed diffuse large B cell lymphoma. Patient underwent 6 cycles of chemotherapy (RCHOP). Interim and post chemotherapy 18F-FDG PET/CT shows complete metabolic resolution of right breast, nodal and bone lesions (Figure). Diffuse FDG uptake in the bone marrow in the interim and post chemotherapy scan is likely related to hyperactive marrow due to chemotherapy administration.
Primary breast lymphoma (PBL) is a rare form of extranodal lymphoma, comprising 0.5% of breast malignancies, 1% of all non-Hodgkin lymphoma (NHL) and less than 3% of extranodal lymphomas.1 Diffuse large B cell lymphoma (DLBCL) is the most common type and over 95% of cases are found in women, and about 11% of cases depicted bilateral breasts involvement.2 The most common clinical manifestation is a palpable, painless breast mass. Imaging findings are non-specific, and usually overlap with breast carcinoma, thus, biopsy of the lesion is warranted for histological confirmation of the diagnosis, given that treatment of PBL and breast carcinoma differs significantly, and local surgical resection is no longer the treatment of choice for PBL.3 18F-FDG PET/CT is extremely useful in the management of lymphoma. Based on the literature review of published cases, 18F-FDG PET-CT has potential role in the initial staging, restaging, and treatment response evaluation in patients with PBL, however because of its low incidence rate, 18F-FDG PET/CT is still not well proven, and further studies are needed to reach a definite conclusion regarding the role of 18F-FDG PET/CT in the management of PBL.4
Conflict of Interest: There are no potential conflicts of interest to disclose.
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4. Santra A, Kumar R, Reddy R, et al. FDG PET-CT in the management of primary breast lymphoma. Clin Nucl Med. 2009; 34:848-853.