Abstract
BackgroundWe report a case of a patient with appendicular bone involvement of diffuse large B-cell lymphoma visualized by whole-body technetium-99m methylenediphosphonate bone scintigraphy (bone scan) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Case presentationA 73-year-old Asian man who had gingival swelling of the labial area of the left maxillary lateral incisor presented to our institution. Positron emission tomography/computed tomography demonstrated hypermetabolic lesions with maximum standardized uptake values of 12.15 in the left testis, 1.92 in the skin of the right chest, and 2.88 in the left ulna and third metatarsal bone. A bone scan showed multiple uptakes in the left ulna, hand, both tibiae, and the left foot. We diagnosed the tumor as diffuse large B-cell lymphoma by excision. Magnetic resonance imaging showed enhanced signaling of lesions with soft tissue edema in the olecranon of the left ulna, the third metacarpal bone of the left hand, and the third metatarsal bone of the left foot. Magnetic resonance imaging findings prompted a diagnosis of lymphoma. Eight cycles of chemotherapy plus external radiotherapy targeted to the involved bone sites were given for 5 months. Follow-up positron emission tomography/computed tomography and bone scanning revealed the disappearance of hypermetabolism and decreased uptake in lesions compared with the previous images. Laboratory data were also all within the normal limits after chemotherapy.ConclusionsThis report highlights that appendicular bone involvement of diffuse large B-cell lymphoma can be detected on whole-body bone scans and by positron emission tomography/computed tomography.
Highlights
We report a case of a patient with appendicular bone involvement of diffuse large B-cell lymphoma visualized by whole-body technetium-99m methylenediphosphonate bone scintigraphy and 18Ffluorodeoxyglucose positron emission tomography/computed tomography.Case presentation: A 73-year-old Asian man who had gingival swelling of the labial area of the left maxillary lateral incisor presented to our institution
This report highlights that appendicular bone involvement of diffuse large B-cell lymphoma can be detected on whole-body bone scans and by positron emission tomography/computed tomography
diffuse large B-cell lymphoma (DLBL) was first diagnosed in the gingival area of the left maxillary lateral incisor, but unrevealed lymphoma involvement on the chest wall, testis, and distal appendicular bone were subsequently detected by whole-body bone scanning and positron emission tomography/computed tomography (PET/CT)
Summary
Secondary DLBL involvement of distal appendicular bone is extremely rare. Bone scanning and PET/CT are important in the diagnosis and response assessment of DLBL involvement of appendicular bone, as in our patient. Bone scanning and PET/CT may be instrumental in establishing a diagnosis of lymphomatous involvement of distal appendicular bone. Abbreviations Bone scan: Technetium-99m methylenediphosphonate bone scintigraphy; CD: Cluster of differentiation; DLBL: Diffuse large B-cell lymphoma; [18F]-FDG: 18F-fluorodeoxyglucose; MRI: Magnetic resonance imaging; PBL: Primary bone lymphoma; PET/CT: Positron emission tomography/computed tomography
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