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August 2022, Volume 72, Issue 8

IMAGING CORNER

Searing abdomen: Infrequent presentation of peritoneal lymphomatosis in Diffuse Large B-Cell Lymphoma on 18F-FDG PET-CT scan

Namra Asghar  ( Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan )
Waqas Ahmad  ( Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. )
Aamna Hassan  ( Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. )

DOI: https://doi.org/10.47391/JPMA.22-89

 

18F-FDG PET-CT scan was performed in a 38-year-old male for baseline staging who presented with obstructive jaundice, significant weight loss and a pancreatic mass. Histopathology revealed DLBCL. PET-CT scan showed hypermetabolic pancreatic head soft tissue lesion encasing CBD with bilateral hypermetabolic peri-renal and extensive omento-peritoneal soft tissue. Destructive osseous lesion was noted in the left femoral neck (Figure-1-A, B, C, D). Subsequent PET-CT done at the end of treatment showed good response with resolution of abdominal disease, however, subsequent PET-CT showed new marrow involvement along with increase in the extent of hypermetabolic infiltrative left femoral mass (Figure-1E). Repeat biopsy of new sites was done before further treatment.

 

 

Nearly 85% of all lymphomas constitute NHL.1 Extra nodal lymphoma may arise from any organ throughout the body and is considered as a poor prognosticator. It is usually seen with NHL.2 Peritoneal lymphomatosis (PL) is a rarely seen form of extra nodal lymphoma and is more frequently seen as secondary involvement of visceral lymphoma. DLBCL is the aggressive and dominant subtype of NHL. PL is associated with aggressive, high-grade lymphomas and is related to poor clinical outcome. Thus, early detection is necessary. Cytology is critical in establishing the diagnosis of PL from ascites with time limitation.3 Use of peritoneal biopsy with high diagnostic accuracy, is limited due to its invasiveness. PET-CT scan has the supremacy of detecting both the primary lesions and peritoneal involvement as compared to conventional CT.

 

References

 

1.      D'souza MM, Jaimini A, Bansal A, et al. FDG-PET/CT in lymphoma. Indian J Radiol Imaging. 2013; 23:354-365.

2.      Curakova E, Genadieva-Dimitrova M, Misevski J, et al. NonHodgkin's Lymphoma with Peritoneal Localization. Case Rep Gastrointest Med. 2014; 2014:723473.

3.      Weng SC, Wu CY. Lymphoma presenting as peritoneal lymphomatosis with ascites. J Chin Med Assoc. 2008; 71:646-50.

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