Abstract
IntroductionThe occurrence of granulomatous disease in the setting of Hodgkin's disease is rare; however, when it occurs it can pose significant clinical and diagnostic challenges for physicians treating these patients.Case presentationWe report the case of a 33-year-old Caucasian woman of Mediterranean descent with newly diagnosed 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) scan-positive, early-stage Hodgkin's disease involving the cervical nodes who, despite having an excellent clinical response to chemotherapy, had a persistent 18F-FDG PET scan-positive study, which was suggestive of residual or progressive disease. A subsequent biopsy of her post-chemotherapy PET-positive nodes demonstrated sarcoidosis with no evidence of Hodgkin's disease.ConclusionThis case highlights the fact that abnormalities observed on posttherapy PET/CT scans in patients with Hodgkin's disease are not always due to residual or progressive disease. An association between Hodgkin's disease and/or its treatment with an increased incidence of granulomatous disease appears to exist. Certain patterns of 18F-FDG uptake observed on PET/CT scans may suggest other pathologies, such as granulomatous inflammation, and because of the significant differences in prognosis and management, clinicians should maintain a low threshold of confidence for basing their diagnosis on histopathological evaluations when PET/CT results appear to be incongruent with the patient's clinical response.
Highlights
The occurrence of granulomatous disease in the setting of Hodgkin’s disease is rare; when it occurs it can pose significant clinical and diagnostic challenges for physicians treating these patients.Case presentation: We report the case of a 33-year-old Caucasian woman of Mediterranean descent with newly diagnosed 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) scanpositive, early-stage Hodgkin’s disease involving the cervical nodes who, despite having an excellent clinical response to chemotherapy, had a persistent 18F-FDG PET scan-positive study, which was suggestive of residual or progressive disease
An increased incidence of granulomatous disease has been associated with Hodgkin’s disease and/or its treatment [2,3,4]; a positive posttherapy PET/CT scan needs to be interpreted with caution, if it is incongruent with the patient’s clinical response
A pretreatment staging 18F-fluorodeoxyglucose (18F-FDG) PET/CT scan was confounded by prominent physiological brown fat uptake in the neck and thorax, but confirmed 18F-FDG-avid lymphadenopathy in the left lower cervical and left supraclavicular regions with no evidence of disease elsewhere in the body (PET scan-confirmed stage IIA Hodgkin’s lymphoma) (Figure 2)
Summary
Abnormalities on PET/CT scans in patients treated for Hodgkin’s disease are not always due to residual or progressive lymphoma, and clinicians should retain a high index of suspicion for alternative pathologies when PET/CT results appear incongruent with the patient’s clinical presentation or response to therapy. Author details 1Department of Nuclear Medicine, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia. AP was responsible for providing anatomical pathology images for the figures, scientific revision of the report and discussion and editing of the manuscript. AH was responsible for the clinical management of the patient, scientific revision of the report and discussion and editing of the manuscript. Competing interests The authors declare that they have no competing interests
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