Abstract
In-111 ibritumomab tiuxetan pretherapy imaging is performed prior to radioimmunotherapy with Y-90 ibritumomab tiuxetan in patients with lymphoma in order to estimate the biodistribution of the radiolabeled antibodies. We report the case of a 61-year-old woman with relapsed follicular lymphoma. In-111 ibritumomab tiuxetan pretherapy imaging showed tracer accumulation in a surgically treated fracture of the left calcaneus as well as in the involved lesions. The patient had fractured her left calcaneus 6 months before the radioimmunotherapy, and fracture of the left calcaneus without lymphoma involvement had been revealed operatively at that time. Clinical features and magnetic resonance imaging (MRI) indicated an inflammatory response in the left heel. We concluded that this inflammation played an important role in the uptake on pretherapy imaging. It should be kept in mind that the inflammation is a differential diagnosis of lymphoma involvement in In-111 ibritumomab tiuxetan pretherapy imaging. To the best of our knowledge, this is the first case report of In-111 ibritumomab tiuxetan uptake in a surgically treated fracture.
Highlights
In January 2008, radioimmunotherapy with Y-90 ibritumomab tiuxetan was approved in Japan
In-111 ibritumomab tiuxetan pretherapy imaging is performed prior to radioimmunotherapy with Y-90 ibritumomab tiuxetan in patients with lymphoma in order to estimate the biodistribution of the radiolabeled antibodies
Whole-body anterior and posterior gamma camera scans at 48 h (a) and 72 h (b) after administration of In-111 ibritumomab tiuxetan show uptake in the left heel in addition to that in the paraaortic, mesenteric, and left iliac lesions, and these findings are compatible with the relapse of lymphoma demonstrated on the positron emission tomography (PET)/computed tomography (CT)
Summary
In January 2008, radioimmunotherapy with Y-90 ibritumomab tiuxetan was approved in Japan This is an effective treatment for refractory or relapsed non-Hodgkin’s lymphoma [1]. It is composed of a radionuclide conjugated to the monoclonal antibody targeting CD20 on the surface of lymphocytes. Patients with altered biodistribution (e.g. prominent bone marrow uptake) on In-111 ibritumomab tiuxetan pretherapy imaging cannot receive Y-90 ibritumomab tiuxetan. We report a patient who underwent radioimmunotherapy with Y-90 ibritumomab tiuxetan for relapsed follicular lymphoma. In this patient, pretherapy imaging using In-111 ibritumomab tiuxetan demonstrated uptake in the involved lesions, and in a surgically treated fracture. To the best of our knowledge, this is the first case report of In-111 ibritumomab tiuxetan uptake in a surgically treated fracture
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