Multiple focal uptake of 67Ga in cutaneous tissue

Abstract

A 69-YEAR-OLD woman presented with multiple skin lesions over the upper extremities. The most prominent lesions were on the left forehead and right zygomatic region and were first noted by the patient 1 year previously. The lesions started as painless areas of erythema with elevation of the skin. Physical examination at presentation showed several erythematous plaquelike lesions on the forehead, chest, and upper extremities. There were no palpable lesions on the right side of the chest, upper abdomen, or buttocks. Skin biopsy was consistent with cutaneous B-cell lymphoma. Bone marrow biopsy was positive for B-cell lymphoma. The patient had pathologic right femoral neck fracture followed by hip replacement. Histopathologic examination showed femoral head and neck involvement with malignant B-cell lymphoma. The patient was referred for 67Ga scan, which was performed 48 hours after the administration of 10 mCi of 67Ga citrate (Fig 1). Computed tomographic scan of the chest, abdomen, and buttocks was performed (Figs 2 and 3). Three months later, the patient underwent a gallium scan to assess the effects of therapy (Fig 4). Cutaneous lymphomas can involve the skin primarily or secondarily and are usually of the T-cell origin 1'2, mycosis fungoides and S6zary syndrome are the most common. Cutaneous B-cell tymphoma is not usually seen and, in most cases, represents secondary cutaneous involvement by systemic lymphoma. Gallium uptake by cutaneous T-cell lymphoma has been reported3; however, 67Ga imaging in cutaneous B-cell lymphoma has rarely been described. 4 Presented here is an unusual case of cutaneous B-cell lymphoma with