Abstract
BackgroundLymphoid neoplasms that present with masses are broadly referred to as lymphomas, and they can be classified to two main groups: Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL); they are mainly characterized by enlargement of lymph nodes (nodal disease) although any organ in the body can be involved in different settings of the disease (extranodal disease). Adequate staging, which has a direct impact on prognosis, is essential to properly plan therapy. Stage IV disease with extranodal dissemination should be treated by long-term systemic chemotherapy.By adding the metabolic changes to the conventional CT morphologic changes, combined positron emission tomography (PET) and computed tomography (CT) may offer clinically useful addition in staging of lymphomas and detection of extranodal lesions.ResultsThe study included thirty nine patients, with forty-eight extranodal sites with lymphomatous infiltration, twenty-four males (61.5%), and fifteen females (38.4%). The patients showed forty-eight extranodal abdominal lymphomatous infiltration.The study included twelve gastric lymphomatous lesions (25%), twelve splenic lymphomatous lesion (25%), three ileo-caecal lymphomatous lesions (6.25%), three patients (6.25%) with skin infiltration, three adrenal lymphomatous lesions (6.25%), three patients with hepatic lymphoma, and twelve bone marrow infiltrations (25%).The most accurate SUV max cutoff value among studied cases was 3.5, the highest SUV max value noted was 21 in gastric lesions, and the lowest SUV max noted was 4.1 in adrenal lesions.Confirmation of PET/CT results was done by histopathological assessment and post-management follow-up.ConclusionPET/CT study is an effective tool for evaluation of extranodal lymphomas. PET/CT fusion images can affect the clinical management plan by detection of extranodal lymphomas with lymphoma staging modification.
Highlights
Lymphoid neoplasms that present with masses are broadly referred to as lymphomas, and they can be classified to two main groups: Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL); they are mainly characterized by enlargement of lymph nodes any organ in the body can be involved in different settings of the disease
There are multiple classification systems of lymphomas, the main histopathological classification of lymphomas into Hodgkin’s disease (40%) and non-Hodgkin’s lymphomas (60%) and several further classifications according to the WHO classification systems in 2008 with about 43 subtypes of lymphomas divided into 4 main groups: mature B cell
We classified the extranodal lesions to two groups: Group I: known extranodal lymphomatous infiltration proved by histopathology and positron emission tomography (PET)/computed tomography (CT) was done for staging searching for lymphoma elsewhere
Summary
Lymphoid neoplasms that present with masses are broadly referred to as lymphomas, and they can be classified to two main groups: Hodgkin’s (HL) and non-Hodgkin’s lymphoma (NHL); they are mainly characterized by enlargement of lymph nodes (nodal disease) any organ in the body can be involved in different settings of the disease (extranodal disease). While secondary extension from a disseminated form is the most frequent forming stage IV disseminated lymphomas, isolated extranodal primary lesions, rare, are possible forming stage IE lymphomas The criteria for such a primary lesion are based on the absence of distant sites (lymph nodes outside of the adjacent drainage area, spleen, bone marrow, or any other distant lymphoid structure) and on the absence of circulating lymphomatous cells, and conflict with any possible involvement by contiguity or with a stage IV disseminated lymphoma [3]. These lymphoma lesions will have a number of common imaging characteristics which are bound to suggest this diagnosis; there are multiple imaging morphological patterns that can mimic other diseases and make the conventional imaging techniques not enough for diagnosis, staging, and assessment of response following chemotherapy or radiotherapy [3, 4].
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