Indian Journal of Nuclear Medicine

CASE REPORT
Year
: 2014  |  Volume : 29  |  Issue : 4  |  Page : 260--261

18 Fluoride-fluorodeoxyglucose positron emission tomography in initial staging and response assessment of primary non-Hodgkin lymphoma of the tibia


Chidambaram Natrajan Balasubramanian Harisankar1, Jijoe John2, Thattaamuriyil Padmakumari Lekshmi2, Arun Warrier3,  
1 Department of Nuclear Medicine and PET CT, Amala Institute of Medical Sciences, Amalanagar, Thrissur, India
2 Department of Radiodiagnosis, Amala Institute of Medical Sciences, Amalanagar, Thrissur, India
3 Department of Medical Oncology, Lakeshore Hospital, Ernakulam, Kerala, India

Correspondence Address:
Chidambaram Natrajan Balasubramanian Harisankar
Department of Nuclear Medicine, Amala institute of Medical Sciences, Amalanagar, Thrissur - 680 555, Kerala
India

Abstract

Primary lymphoma of the bone is a rare clinical presentation constituting to <1% of all lymphomas. The long bones are usually involved. Combined treatment with chemotherapy and radiation offers long-term survival. The authors present the role of 18 fluoride-fluorodeoxyglucose positron emission tomography-computerized tomography in initial staging and response assessment in a case of primary diffuse large B cell lymphoma of the tibia.



How to cite this article:
Harisankar CB, John J, Lekshmi TP, Warrier A. 18 Fluoride-fluorodeoxyglucose positron emission tomography in initial staging and response assessment of primary non-Hodgkin lymphoma of the tibia.Indian J Nucl Med 2014;29:260-261


How to cite this URL:
Harisankar CB, John J, Lekshmi TP, Warrier A. 18 Fluoride-fluorodeoxyglucose positron emission tomography in initial staging and response assessment of primary non-Hodgkin lymphoma of the tibia. Indian J Nucl Med [serial online] 2014 [cited 2022 Oct 6 ];29:260-261
Available from: https://www.ijnm.in/text.asp?2014/29/4/260/142636


Full Text

 INTRODUCTION



Primary bone lymphoma is a rare, but distinct clinical entity. Both Hodgkin and non-Hodgkin lymphoma (NHL) can involve the bones. The involvement may be solitary or multi-focal. Patients with primary bone lymphoma usually have a good prognosis. Combined treatment with chemotherapy and radiation has good response with the majority of the low-risk patients surviving until 10 years. We present the role of 18 fluoride-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (18F-FDG PET-CT) in an interesting case of primary diffuse large B cell lymphoma (DLBCL) of the tibia.

 CASE REPORT



A 53-year-old-male patient who presented with pain and swelling of the right lower limb was evaluated. A biopsy from the swelling revealed DLBCL. He was referred to our center for a whole body 18F-FDG PET-CT for initial staging. Pretreatment 18F-FDG PET-CT of the thigh and leg showed intense metabolic activity in a large soft tissue mass arising from the proximal part of right tibia [Figure 1]. No abnormal metabolic activity was noted in the rest of the body.

The patient underwent chemotherapy and local radiation to the involved site and was referred for an 18F-FDG PET-CT 3 months after the completion of treatment. Posttreatment 18F-FDG PET-CT was normal with complete regression of previously noted abnormality [Figure 2].{Figure 1}{Figure 2}

 DISCUSSION



Extra nodal lymphomas are fairly common. Primary bone lymphomas represent approximately 5% of the extranodal lymphomas, majority of which are DLBCL. [1] Primary bone lymphomas constitute to <1% of all NHL. [2] Primary Hodgkin lymphoma of the bone is extremely rare. [3] Most patients present with localized pain, swelling or pathological fracture. They can arise from any bone, but long bones (femurs and tibiae) are the common sites. 18F-FDG PET CT helps in identification of lymph nodal involvement and also differentiation of monostotic from polyostotic involvement by lymphoma. 18F-FDG PET-CT is beneficial in the response assessment and effectiveness of treatment. Viable tumor lesions are difficult to be differentiate from bone fibrosis and remodeling using conventional modalities. 18F-FDG PET is also more sensitive than magnetic resonance imaging in identifying response. [4] Primary lymphoma involving the bone usually has an excellent prognosis. [5] Patients treated with combined modality versus single modality therapy were found to have a superior outcome, with a significantly better survival. The 5-year overall survival for patients treated with combined modality was 95% in one of the largest studies. [5] Reports on the utility of 18F-FDG PET-CT in primary bone lymphomas have also been published. [6],[7] Role of 18F-FDG PET-CT in initial staging and response assessment in lymphomas has been well-established. [8],[9] This case reports adds to the existing knowledge that 18F-FDG PET-CT is a useful modality in assessment of primary bone lymphoma.

References

1Mikhaeel NG. Primary bone lymphoma. Clin Oncol (R Coll Radiol) 2012;24:366-70.
2Kitsoulis P, Vlychou M, Papoudou-Bai A, Karatzias G, Charchanti A, Agnantis NJ, et al. Primary lymphomas of bone. Anticancer Res 2006;26:325-37.
3Oshikawa G, Arai A, Sasaki K, Ichinohasama R, Miura O. Primary multifocal osseous Hodgkin lymphoma. Rinsho Ketsueki 2009;50:92-6.
4Park YH, Kim S, Choi SJ, Ryoo BY, Yang SH, Cheon GJ, et al. Clinical impact of whole-body FDG-PET for evaluation of response and therapeutic decision-making of primary lymphoma of bone. Ann Oncol 2005;16:1401-2.
5Beal K, Allen L, Yahalom J. Primary bone lymphoma: Treatment results and prognostic factors with long-term follow-up of 82 patients. Cancer 2006;106:2652-6.
6Kalkanis D, Kalkani M, Gomes H, Paes F, Sideras P, Sfakianakis GN. Interesting image. FDG-PET/CT in primary large B-cell lymphoma of the hard palate. Clin Nucl Med 2010;35:24-5.
7Bosch-Barrera J, Arbea L, García-Velloso MJ, Gil-Bazo I, García-Foncillas J, Panizo C. Primary bone lymphoma of the mandible and thyroid incidentaloma identified by FDG PET/CT: A case report. Cases J 2009;2:6384.
8de Geus-Oei LF, Vriens D, Arens AI, Hutchings M, Oyen WJ. FDG-PET/CT based response-adapted treatment. Cancer Imaging 2012;12:324-35.
9Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med 2009;50 Suppl 1:21S-30.