Involvement Of Malignant Lymphoma Research Articles

Radiomics analysis for differentiating of cervical lymphadenopathy between cancer of unknown primary and malignant lymphoma on unenhanced computed tomography.

ABSTRACTTo investigate the usefulness of texture analysis to discriminate between cervical lymph node (LN) metastasis from cancer of unknown primary (CUP) and cervical LN involvement of malignant lymphoma (ML) on unenhanced computed tomography (CT). Cervical LN metastases in 17 patients with CUP and cervical LN involvement in 17 patients with ML were assessed by 18F-FDG PET/CT. The texture features were obtained in the total cross-sectional area (CSA) of the targeted LN, following the contour of the largest cervical LN on unenhanced CT. Values for the max standardized uptake value (SUVmax) and the mean SUV value (SUVmean), and 34 texture features were compared using a Mann-Whitney U test. The diagnostic accuracy and area under the curve (AUC) of the combination of the texture features were evaluated by support vector machine (SVM) with nested cross-validation. The SUVmax and SUVmean did not differ significantly between cervical LN metastases from CUP and cervical LN involvement from ML. However, significant differences of 9 texture features of the total CSA were observed (p = 0.001 – 0.05). The best AUC value of 0.851 for the texture feature of the total CSA were obtained from the correlation in the gray-level co-occurrence matrix features. SVM had the best AUC and diagnostic accuracy of 0.930 and 84.8%. Radiomics analysis appears to be useful for differentiating cervical LN metastasis from CUP and cervical LN involvement of ML on unenhanced CT.

Primary advanced non-Hodgkin’s lymphoma of bladder with bilateral hydroureteronephrosis: A case report

Primary lymphoma of bladder is a very rare entity with a 0.2% incidence of all bladder malignancies. Secondary bladder involvement in malignant lymphoma is more common (10-25%) with preponderance in middle aged females. A non-Hodgkin lymphoma of the bladder can be managed conservatively without surgery and has a better prognosis. Because the presenting symptoms and radiological imaging cannot conclusively rule out a primary bladder lymphoma from other malignant causes, cystoscopy and biopsy with immune-histochemical staining is essential. We present to you a 72-year-old male with complaints of irritative lower urinary tract symptoms and asymptomatic microhematuria. On evaluation computerized tomography (CT) was s/o a large bladder wall mass with bilateral mild hydroureteronephrosis and enlarged pelvic lymphnodes. Cystoscopy and biopsy was done and the report came out to be a non-Hodgkins lymphoma. Whole body positron emission tomography (PET) scan was done which confirmed it to be a primary bladder NHL. Patient was treated with chemotherapy and is now doing well on follow up. We would like to share our experience in managing this case.

A Case of Cardiac Involvement in Malignant Lymphoma With Sick Sinus Syndrome Improved by Chemotherapy

A Case of Cardiac Involvement in Malignant Lymphoma With Sick Sinus Syndrome Improved by Chemotherapy

Bone Marrow Involvement in Malignant Lymphoma: Evaluation of Quantitative PET and MRI Biomarkers

This study aimed to determine the diagnostic utility of standardized uptake values (SUV) and apparent diffusion coefficients (ADC) for assessment of focal and diffuse bone marrow involvement in patients with malignant lymphoma. Sixty treatment-naive patients (28 males; mean age 51.2 ± 16.7 years) with histologically proven lymphoma, who underwent fludeoxyglucose (18F) positron emission tomography-computed tomography ([F18]-FDG-PET/CT) and whole-body diffusion-weighted imaging (WB-DWI) within 7 days, and also routine bone marrow biopsy, were included in this institutional review board-approved, retrospective study. The maximum SUV (SUVmax) on [F18]-FDG-PET/CT, and the mean ADC (ADCmean, ×10-3 mm2/s) on whole-body-DWI, were extracted from focal lesions, or, in their absence, from the thoracic (Th8) and lumbar vertebral bodies (L4), the sacral bone (S1), and the iliac crest. Lesion-to-liver-ratios (SUVmax-ratio) were calculated. Pearson correlation coefficients were used to assess the correlation between SUVmax-ratios and ADCmean values. Bone marrow involvement was observed in 16 of 60 patients (8 of 16 with diffuse infiltration). The SUVmax-ratio cutoff value was 95.25% for focal and 70.2% for diffuse bone marrow involvement (sensitivity/specificity of 87.5%/86.4% and 100%/43.2%, respectively). The ADCmean cutoff value was 0.498 for focal and 0.401 for diffuse bone marrow involvement (sensitivity/specificity of 100%/90.9% and 87.5%/56.8%, respectively). No significant correlations were found between SUVmax-ratios and ADCmean values in the different groups. With the liver as reference tissue, quantitative [F18]-FDG-PET/CT may be useful to differentiate bone marrow involvement from normal bone marrow in patients with lymphoma, even though the specificity for diffuse marrow involvement is rather low. Quantitative DWI can be used only to distinguish focal bone marrow lesions from normal bone marrow.

P14.10 Secondary CNS involvement in malignant lymphoma: Data from a multicenter prospective international registry

P14.10 Secondary CNS involvement in malignant lymphoma: Data from a multicenter prospective international registry

674 - Problems of diagnosis of cardiac involvement in malignant lymphoma in children

674 - Problems of diagnosis of cardiac involvement in malignant lymphoma in children

Follicular lymphoma-related colitis resembling ulcerative colitis

Among the various manifestations of colonic involvement in malignant lymphomas, an ulcerative colitis-like appearance is rare. Herein, we describe a case in which extranodal colonic involvement resembled ulcerative colitis in a patient with advanced follicular lymphoma. A 59-year-old Japanese man with diarrhea and body weight loss was referred to our hospital. Computed tomography (CT) revealed systemic lymphadenopathy, splenomegaly, and thickening of the sigmoid colon and rectum walls. 18F-fluorodeoxy-glucose positron emission tomography (18F-FDG-PET/CT) revealed intense tubular 18F-FDG accumulation extending from the rectum to the colon at the hepatic flexure and much weaker accumulation in the systemic lymph nodes, bone marrow, and spleen. The isotope-enriched areas had an ulcerative colitis-like appearance as shown via colonoscopy. The patient was ultimately diagnosed with follicular lymphoma (stage IV A, grade 1) based on a pathological examination of the neck lymph nodes, iliac bone marrow, and colon. After six courses of chemotherapy (R-CHOP), 18F-FDG-PET/CT confirmed complete remission of the lymphoma including the colonic lesion. This is presumably the first case of ulcerative-like colitis caused by a follicular lymphoma. As a novel approach, the lymphoma-related colitis was detected by comparing the pathology results and the 18F-FDG-PET/CT results.

Malignant lymphoma in Hadhramout Sector, Yemen: a retrospective study of 170 cases classified according to the WHO classification

Introduction Malignant lymphoma is a primary neoplasm of lymphoid tissue. It is the third most common cancer in children worldwide. There are two broad categories of malignant lymphomas: non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). Both have different microscopic features, follow different treatment modalities, and have different prognoses. Aim of the work The aim of the study was to determine the different types of lymphoma in all age groups, and find its relation to sex and site of lymph node involvement in Hadhramout Governorate. Materials and methods This is a retrospective descriptive study of 170 cases of lymphomas retrieved from the archives of the National Oncology Center, Hadhramout, during the period between 2008 and 2013. The diagnosis was assessed with immunohistochemical results and categorized according to the WHO classification of lymphoid neoplasms. Results Out of 170 patients, 116 (68.2%) had NHL and 54 (31.8%) had HL. A male predominance was observed (103/170, 60.6%). B-cell lymphomas were the most frequent type of NHL (95/116, 81.9%) and diffuse large B-cell lymphoma was the most common pattern of NHL (58/95, 61.1%), followed by Burkitt's lymphoma (20/95, 21.1%). The distribution of HL showed predominance of nodular sclerosis classical HL (38/54, 70.4%). The proportion of lymph node involvement of lymphomas was higher than extranodal involvement, being seen in 91/116 cases (78.5%) of all NHLs and 49/54 cases (90.8%) of all HLs. Conclusion NHL is the most common type of malignant lymphoma, and diffuse large B-cell lymphoma is the most common pattern among all NHL types, whereas nodular sclerosis classical HL is the most common type of HL. The nodal involvement of malignant lymphoma is higher than extranodal involvement.

FDG PET/MR for the Assessment of Lymph Node Involvement in Lymphoma: Initial Results and Role of Diffusion-Weighted MR

The purpose of this study was to evaluate the sensitivity and specificity of positron emission tomography/magnetic resonance imaging (PET/MR) with 18F-fluorodeoxyglucose (FDG) for nodal involvement in malignant lymphoma. Twenty-seven patients with malignant lymphoma (16 men and 11 women; mean age, 45 years) were included in this retrospective study. The patients underwent FDG PET/MR after intravenous injection of FDG (176-357 MBq FDG, 282 MBq on average). Follow-up imaging and histology served as the standard of reference. One-hundred and twenty-seven (18.1%) of 702 lymph node stations were rated as having lymphoma involvement based on the standard of reference. One-hundred and twenty-four (17.7%) of 702 lymph node stations were rated as positive by FDG PET/MR. The sensitivity and specificity of FDG PET/MR for lymph node station involvement were 93.8% and 99.4%. FDG PET/MR is feasible for lymphoma staging and has a high sensitivity and specificity for nodal involvement in lymphoma. Comparison with PET/CT is necessary to determine whether FDG PET/MR can replace PET/CT for lymphoma staging.

Cardiac involvement of malignant lymphoma and its improvement after chemotherapy

A 63-year-old female was admitted to the emergency room in our hospital due to chest oppression at rest. Physical examination showed no significant abnormal findings. Her heart rate was 92 beats/min and blood pressure was 158/92 mmHg. Laboratory findings showed no abnormal data. ECG on admission showed normal sinus rhythm with first-degree atrio-ventricular block and negative T wave in II, III, aVF, and low voltage in limb leads. Echocardiography revealed wall thickening in the infero-posterior segments of the left ventricle (LV) with wall motion abnormality, and wall thickening in intra-atrial septum and right atrium (Fig. 1). In echocardiograms, end-diastolic and end-systolic LV diameter, septal and posterior wall thickness, and ejection fraction were 40, 23, 9, 9 mm, and 50 %, respectively. Pulsed Doppler echocardiography showed pseudonormal pattern in transmitral flow [early diastolic and atrial wave velocity ratio (E/A) = 1.75, deceleration time = 113 ms]. Tissue Doppler echocardiography showed a ratio of early diastolic transmitral flow and mitral annulus velocity (E/E0) of 15.5. Coronary angiogram revealed no significant coronary stenosis. Computed tomography (CT) scan revealed (1) multiple masses in left iliopsoas muscle, (2) lymph node swelling in the paraaortic and right inguinal portions, and (3) wall thickening in the LV, right atrium, and intra-atrial septum. She was diagnosed as having diffuse large B cell lymphoma by biopsy from the lymph node in the right inguinal portion. Chemotherapy was performed (R-CHOP, 7 courses). Follow-up echocardiograms showed a decrease in cardiac mass after the second course of R-CHOP. ECG showed normal findings, and no apparent mass was found by CT scan. After the completion of the chemotherapy, echocardiography revealed no wall thickening and improvement in the inferior wall motion (Fig. 2). E/A was decreased from 1.75 to 0.87. E/E0 was decreased from 15.5 to 11.5. Secondary cardiac involvement of lymphoma has been reported as between 16 and 28 % of extracardiac lymphomas [1–3]. These results were obtained from autopsy studies. However, cardiac involvement is not commonly diagnosed before an autopsy [3–5] for the following reasons. It is usually asymptomatic or a nonspecific symptom in cardiac involvement in patients with lymphoma because most of the cardiac involvement of lymphoma is microscopic. ECG usually shows nonspecific findings in cardiac involvement. Symptoms and signs due to coexistent involvement of other organs may induce misdiagnosis of cardiac involvement. Myocardial or atrial wall thickening as shown in the present echocardiograms has been reported in previous reports of cardiac involvement of lymphoma [3, 4]. Infiltration of tumor cells in these lesions has been shown in the autopsy in the previous reports. Echocardiography revealed a decrease in myocardial and atrial wall thickening after 4 courses of chemotherapy, and no wall thickening after the completion of the chemotherapy, which was confirmed by CT scan. In comparison with CT, echocardiography is a completely noninvasive and feasible method. Thus, echocardiography is more useful than CT for the serial assessment of the involved mass in the heart after chemotherapy. This case shows the usefulness of echocardiography H. Ochi (&) M. Yamamoto M. Yamasaki Echocardiography Laboratory, Osaka Saiseikai Noe Hospital, 1-3-25 Furuich, Joutou-ku, Osaka 536-0001, Japan e-mail: hiroyuki18ochi@yahoo.co.jp

Study of Staging and Prognostic Significance of Bone Marrow Involvement in Malignant Lymphomas in Northern India : Clinicopathological Study

Introduction: Bone marrow is not only a reservoir of stem cells but also provides microenvironment for proliferation and development of precursors and regulate the release of mature cells in to circulation. Bone is commonly involved in metastatic tumors and rank third most common site of metastasis after lung and liver. Metastasis may be present in the bone marrow without any abnormalities recognized in bone scans, radiographic pictures, serum chemistry and hematological parameters and remain the only procedure to diagnose the presence of metastatic tumor. AIMS: To study the clinical features&characteristics of BM involvement in NHL& HL cases with respect to morphology of infiltration for staging and their prognosis. Materials and Method: A prospective study was conducted on 38cases who had not received any prior specific treatment (chemotherapy and radiotherapy) for both Hodgkin's and non-Hodgkin's lymphoma from northern India, . Out of 38 cases Hodgkin's lymphoma were 08 cases and non- Hodgkin's lymphoma were 30 cases . All cases were examined clinically and later on Bone marrow aspiration and Bone marrow biopsy was obtained from the posterior superior iliac spine. The biopsies were fixed in 10% buffered formalin solution and decalcified using 10% formal - formic acid for 4 - 6 h followed by routine processing. The serial sections were stained by hematoxylin and eosin and reticulin stains. The smears were air dried and immediately fixed in methanol for one of the Romanowsky stain (We used Leishman stain and May-Grunwald Geimsa stain) for cellularity and morphology1. Serial aspiration and biopsies were done in all cases of Hodgkin's and non-Hodgkin's lymphoma Observations: The most prominent clinical feature was cervical lymphadenopathy. Patients with advanced disease had systemic features like fever, weight loss and hepatosplenomegaly. The incidence of marrow involvement in known case of Hodgkin's and non-Hodgkin's lymphoma was 25% and 43.33% respectively. The incidence of bone marrow involvement was found in mixed cellularity and in lymphocyte depletion type of Hodgkin Lymphoma cases and the pattern of involvement of bone marrow was diffuse in all the cases. The extent of marrow involvement was greatest in Non Hodgkin lymphomas that exhibit a diffuse pattern of infiltration. In thirteen cases (43.33%) of bone marrow involvement, seven cases (53.8%) showed presence of neoplastic cells in both aspiration and biopsy while six cases (46.2%) showed presence of neoplastic cells in bone marrow biopsy. Serial aspiration and biopsies revealed that both cases (100%) of Hodgkin's lymphoma improved with systemic chemotherapy, while five cases (38.46%) of non-Hodgkin's lymphoma showed clearance of bone marrow by the neoplastic cells on completion of chemotherapy. Conclusion: In all the cases, which infiltrated to bone marrow, histological grades were same as in the FNAC / Histopathology examination at the time of diagnosis from the primary site. Bone marrow aspiration and biopsy were performed as complimentary procedures. But Bone marrow biopsy was found superior to bone marrow aspiration.. It was also helpful in the management strategy of the disease as well as to see the response of the therapy by serial aspiration and biopsies10. It was found that in five cases (38.46%) of non-Hodgkin's lymphoma bone marrow showed clearance of tumor cells after completion of chemotherapy.

Burkitt Lymphoma: An Unusual Cause of Obstructive Jaundice

Introduction: Lymphomatous infiltration of the biliary tree is rare. While it has been reported to occur in certain subtypes of Non Hodgkin's lymphomas (NHL), Burkitt lymphoma of the biliary tree or the gall bladder is extremely uncommon with less than five cases reported in English literature so far. We report a case of a patient with Burkitt lymphoma who presented with obstructive jaundice and was found to have lymphomatous infiltration of gall bladder and common bile duct. Case: A 40-year-old Caucasian male with recently diagnosed Burkitt lymphoma was admitted to the hospital with abdominal pain and jaundice. Liver injury tests were noted to be elevated in an obstructive pattern. CT scan of abdomen showed thickening of gall bladder wall and a dilated common bile duct. CT guided core biopsy of gall bladder was done which revealed transmural infiltration with Burkitt lymphoma. Endoscopic retrograde cholangiopancreaticography (ERCP) showed a prominent ampulla with dilation of extrahepatic biliary ducts. No strictures or obstructive calculi were noted on cholangiogram. Sphincterotomy with plastic stent placement was performed resulting in good bile flow and rapid improvement in jaundice. Ampullary and distal common bile duct biopsies were positive for lymphomatous infiltration. The hospital course was complicated by acute respiratory failure secondary to hospital-acquired pneumonia and worsening bilateral pleural effusions. The patient eventually opted for comfort care and died in the hospital. Discussion: Hepatobiliary involvement in malignant lymphomas usually occurs with infiltration of liver or external compression of the extrahepatic biliary system. Lymphoma infiltrating the extrahepatic biliary system is rare and has been reported to occur with NHLs. Diffuse large B cell lymphoma is the most frequently reported NHL subtype to involve the biliary system. The usual presenting symptoms are nausea, vomiting, anorexia, abdominal pain, weight loss and jaundice. This constellation of symptoms can mimic cholangiocarcinoma which is the most common tumor of biliary system. Though diagnosis can be established by brushings or biopsy of the common bile duct, it is only made after surgical resection in many cases. Chemotherapy is the most effective treatment and delay in its institution due to confusing clinic picture can lead to poor clinical outcome. Conclusion: Non Hodgkin's lymphoma of the extrahepatic biliary tree is a rare cause of bile duct obstruction and jaundice. Though rare, it should be considered in the differential diagnosis in appropriate clinic settings as early diagnosis is the key to good outcomes.

Whole‐body magnetic resonance imaging, including diffusion‐weighted imaging, for diagnosing bone marrow involvement in malignant lymphoma

T. Kwee, R. Fijnheer, I. Ludwig, H. Quarles van Ufford, C. Uiterwaal, M. Bierings, T. Takahara, and R-J. Nievelstein Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands, Department of Hematology, Meander Medical Center, Amersfoort, Netherlands, Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht, Netherlands

Hodgkin's lymphoma presenting with heart failure: a case report

IntroductionCardiac involvement in malignant lymphoma is one of the least investigated subjects in oncology. This article reports a case of cardiac involvement in Hodgkin's lymphoma which presented as heart failure.Case presentationWe report the case of an 8-year-old Afghan girl with Hodgkin's lymphoma. The disease presented with systemic signs and symptoms, including abdominal distension, weakness, pallor, chills, fever, generalized edema, hepatosplenomegaly and generalized lymphadenopathy, as well as signs of heart failure. Test results showed a rare form of heart metastasis.ConclusionWe report a case of Hodgkin's lymphoma with metastasis to the heart, detected premortem. Although the involvement of the heart in a malignancy is relatively common, premortem detection is unusual and only few studies have reported it in the literature.

Primary Bilateral Adrenal Diffuse Large B-cell Lymphoma Demonstrating Adrenal Failure

Primary adrenal lymphoma (PAL) is extremely rare although involvement of malignant lymphoma into adrenals is common. We report a case of a 58-year-old man with bilateral PAL who demonstrated adrenal insufficiency. Primary large B-cell lymphoma was proven by a computed tomography-guided needle biopsy of the adrenal tumor. Although a complete remission was once achieved by combination chemotherapy plus rituximab, a recurrence occurred with brain metastasis leading to his death. We concluded that PAL should be considered as a possible cause of bilateral adrenal incidentalomas with progressive adrenal insufficiency.

Exploring the role of FDG-PET in the assessment of bone marrow involvement in lymphoma patients as interpreted by qualitative and semiquantitative disease metabolic activity parameter

Bone marrow biopsy (BMB) is currently the standard method to evaluate marrow involvement in malignant lymphomas. However, there exist a number of pitfalls in this technique that can have important implications for initial staging, prognostification, and treatment of the disease. The present study was undertaken to investigate the utility of FDG-PET imaging in the detection of bone marrow involvement in untreated lymphoma patients. Forty untreated patients (36 males and 12 females) with either Hodgkin's disease (HD) (n = 17) or non-Hodgkin's lymphoma (NHL) (n = 31) underwent whole body FDG-PET study for disease evaluation. Bone marrow uptake of FDG was graded as absence or presence of disease activity at marrow sites by qualitative assessment. Semiquantitative analysis involved deriving disease metabolic index (DMI) using the following formula: DMI = SUV max of suitable circular ROI over PSIS or trochanteric region/ SUVmax of similar ROI over adjoining background. Findings of BMB and FDG-PET were compared for final analysis. Eleven out of 17 HD patients (12 males and 5 females) demonstrated concordance between FDG PET findings and BMB reports. Remaining 6 cases showed discordance of FDG-PET demonstrating presence of marrow involvement at marrow sites and uninvolved marrow on BMB. Twenty six of the 31 NHL cases (24 males and 7 females) demonstrated concordance between FDG PET findings and BMB reports. Remaining 5 cases showed discordance of FDG-PET demonstrating presence of marrow involvement at marrow sites and uninvolved marrow on BMB. All the BMB positive patients (2 of HD and 5 of NHL) demonstrated disease activity in bone marrow on FDG-PET study. All patients with absence of disease activity at marrow sites on FDG-PET scan (9 of HD and 21 of NHL) had histology proven uninvolved marrow. The quantitative assessment by DMI showed a mean of > 2.5 in HD and NHL patients at the PSIS region and the trochanteric region bilaterally in cases of bone marrow involvement by the disease. FDG-PET is a useful adjuvant to BMB for the evaluation of bone marrow involvement in lymphoma patients. The disease metabolic index of > 2.5 at the marrow sites can serve as a semiquantitative parameter for such diagnosis on FDG-PET in untreated patients of lymphoma.

Detection of a cardiac mass by [18F]FDG-PET/CT: a rare case

Intra-cardiac masses present an important problem in cardiology. The differential diagnoses includes tumours, which may be primary (benign or malignant) or metastatic, and infected mural thrombi.Myxomas, sarcomas, breast, lung and renal cancer represent the commonest causes of primary benign, malignant and metastatic intra-cardiac masses, respectively.Recent studies have shown that cardiac involvement in malignant lymphoma is common but under-investigated.Diagnostic imaging techniques for detection of cardiac masses include echocardiography, CT and MRI, with echocardiography having the highest sensitivity. We propose that 18-F-PET/CT may play an important role in the detection and evaluation of intra-cardiac masses.

CT and 18F-FDG PET for Noninvasive Detection of Splenic Involvement in Patients with Malignant Lymphoma

The purpose of this study was to determine the sensitivity and specificity of (18)F-FDG PET, CT, and combined PET/CT in the detection of splenic involvement at initial staging of lymphoma. A retrospective longitudinal analysis was performed on the records of 111 patients with proven lymphoma who had undergone PET and CT before and after treatment. CT scans were evaluated independently by two radiologists, and PET scans by two nuclear medicine physicians. Abnormal CT findings were defined as low-attenuation nodules or a splenic index greater than 725 cm(3) (> 2 SDs above the mean in 100 controls). An abnormal PET finding was defined as splenic uptake greater than hepatic uptake. True splenic involvement was defined retrospectively on the basis of the treatment response assessed with criteria revised in the International Harmonization Project on lymphoma. Observer agreement and sensitivity and specificity values were calculated. Observer agreement for CT splenic index and PET findings was good. For initial splenic staging, the sensitivity and specificity of CT, PET, and PET/CT were 91% and 96%, 75% and 99%, and 100% and 95%. For initial staging of splenic involvement in malignant lymphoma, the sensitivity and specificity of PET/CT can reach 100% and 95%. The sensitivity of the combined approach is higher than that of either technique alone.

Superior Clinical Impact of FDG-PET Compared to MRI for the Follow-up of a Patient with Sacral Lymphoma

The assessment of residual tumors after treatment of malignant lymphoma (ML) is often difficult. Here we report a case of non-Hodgkin's lymphoma with a huge sacral tumor. After chemotherapy and following radiation therapy, a residual mass was detected on magnetic resonance imaging (MRI). However, a hypermetabolic lesion in the sacrum disappeared on (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and clinically the patient was considered to achieve complete remission. Seven months after the completion of radiation therapy, a new tumor-like lesion in the sacrum developed on MRI, but hypermetabolic lesions were not detected on (18)F-FDG-PET. Recurrence of lymphoma was denied by open biopsy of the lesion. (18)F-FDG-PET has been of widespread use not only for staging but for post-treatment assessment of ML. Although MRI is a standard imaging tool for the assessment of bone involvement of ML, there have been few reports documenting the results of comparative studies on the usefulness of (18)F-FDG-PET and MRI for the evaluation of residual mass in bone involvement of ML. The present case suggests that (18)F-FDG-PET is superior to MRI not only in the evaluation of a residual mass but in the judgment of recurrence after treatment of such patients.

Investigation of bone marrow involvement in malignant lymphoma using fluorescence in situ hybridization: possible utility in the detection of micrometastasis

We evaluated the usefulness of interphase fluorescence in situ hybridization (FISH) for the detection of bone marrow involvement of lymphoma, comparing the results with those of microscopic examination. Bone marrow aspirates obtained for staging work-up from 150 patients with non-Hodgkin lymphoma were used in this study. Interphase FISH study using four probes and conventional G-banding were performed on bone marrow aspirates. The four probes included locus specific identifier (LSI) immunoglobulin heavy chain (IGH) dual-color break-apart rearrangement probe, an LSI p16 SpectrumOrange/CEP 9 SpectrumGreen probe, an LSI BCL6 dual-color break-apart rearrangement probe. Among 150 cases, 29 cases (19.3%) showed infiltration of neoplastic lymphoid cells by microscopic examination. Chromosomal aberrations were detected by FISH in eight patients and by conventional cytogenetic study in three patients. FISH study showed 14q32 rearrangement in four patients (4/126, 3.2%), 9q21 rearrangement in no patients (0/144, 0%), 3q27 rearrangement in four patients (4/131. 3.1%), and a gain of 1q21q32 in two patients (2/115, 1.7%). Among eight patients with abnormal FISH patterns, six had normal karyotypes or no analyzable metaphase according to the conventional cytogenetic study. Seven patients with FISH abnormality showed bone marrow involvement of lymphoma by microscopic examination. One patient, who was defined as having no evidence of bone marrow involvement by microscopic examination, showed a 3q27 aberration in the FISH study. Although the number of patients with BM involvement that was detected by FISH was low, abnormal FISH patterns were detected in six patients who did not have abnormal karyotypes. Therefore, FISH analysis would be beneficial in cytogenetic diagnosis and follow-up study of minimal residual diseases, once the cytogenetic changes are detected at initial diagnosis.