J Korean Soc Radiol.  2019 May;80(3):548-554. 10.3348/jksr.2019.80.3.548.

Clinically Occult Diffuse Large B-Cell Lymphoma of the Middle Turbinate Identified Using ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Case Report

• Kim DH
• Lee SK
• Kim MJ
• Yi JH
• Choi MS

• KMID: 2454034
• DOI: http://doi.org/10.3348/jksr.2019.80.3.548

Abstract

We report a case of clinically occult diffuse large B-cell lymphoma (DLBCL) of the middle turbinate (MT) identified by ¹â¸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹â¸F-FDG PET/CT) in a 71-year-old man along with imaging findings. DLBCL was presented with a hypermetabolic right MT [maximum standardized uptake values (SUV(max)) = 8.8 gm/dL] on ¹â¸F-FDG PET/CT, while rhinologic examination was normal. CT showed nothing but slightly more intense enhancement of the right MT compared with the opposite side. The disease progressed during next 7 months until follow-up CT demonstrated solidly enhancing mass occupying entire right nasal cavity which was intensely hypermetabolic (SUV(max) = 12.8 gm/dL). Surgical biopsy confirmed the diagnosis. Follow-up CT and 18F-FDG PET/CT performed after chemotherapy demonstrated complete resolution of DLBCL of the right nasal cavity including the right MT. This is thought to be the first case report in the literature concerning clinically occult DLBCL presenting as a hypermetabolic MT on ¹â¸F-FDG PET/CT.

MeSH Terms

Aged
B-Lymphocytes*
Biopsy
Diagnosis
Drug Therapy
Electrons*
Fluorodeoxyglucose F18
Follow-Up Studies
Humans
Lymphoma, B-Cell*
Lymphoma, Large B-Cell, Diffuse
Nasal Cavity
Positron-Emission Tomography and Computed Tomography
Turbinates*
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1. A 71-year-old man with DLBCL of the MT detected using18F-FDG PET/CT that was performed for metastasis work-up of HCC. A. 18F-FDG PET/CT performed 14 months prior when he had undergone partial hepatectomy reveals no abnormal uptake in the sinonasal area (first image).18F-FDG PET/CT performed for metastasis work-up of HCC demonstrates hypermetabolic right MT (SUVmax = 8.8 gm/dL) (arrow) (second image). No abnormal uptake is noted at other sinonasal areas.18F-FDG PET/CT obtained 7 months thereafter shows an intensely hypermet-abolic mass (SUVmax = 12.8 gm/dL) (arrows) occupying the right nasal cavity (third image).18F-FDG PET/CTafter R-CHOP chemotherapy shows complete resolution of DLBCL of the right nasal cavity with normal appearing MT (arrow) (fourth image). B. Contrast-enhanced axial (first image) and coronal (second image) CT for further evaluation of hypermeta-bolic MT on18F-FDG PET/CT show morphologically normal right MT with slightly more intense enhancement compared to that on the opposite side (arrows). C. Follow-up contrast-enhanced axial CT (first image) obtained 7 months thereafter shows a mass with moderate enhancement in the right nasal cavity (arrows). Bony erosion and remodeling of the medial wall of the right maxillary sinus, right middle and inferior turbinates, and right ethmoid sinus are also noted on the coronal CT (arrows) (second image). CT = computed tomography, DLBCL = diffuse large B-cell lymphoma,18F-FDG =18F-fluorodeoxyglucose, HCC = hepatocellular carcinoma, MT = middle turbinate, PET = positron emission tomography, R-CHOP = cyclophosphamide, doxorubicin, vincristine, prednisolone, rituximab, SUVmax = maximum standardized uptake values

• 

  Fig. 1. A 71-year-old man with DLBCL of the MT detected using18F-FDG PET/CT that was performed for metastasis work-up of HCC. D. Follow-up axial (first image) and coronal (second image) CT after R-CHOP chemotherapy shows complete resolution of the mass of the right nasal cavity with normal-appearing MT (arrows). E. Histologic findings of the specimen obtained by surgical biopsy of the mass of the right nasal cavity demonstrates monotonous proliferation of medium to large lymphoid cells (first image; hematoxylin and eosin stain, × 200) with positivity for CD20 (second image; immunostaining, × 200). CT = computed tomography, DLBCL = diffuse large B-cell lymphoma,18F-FDG =18F-fluorodeoxyglucose, HCC = hepatocellular carcinoma, MT = middle turbinate, PET = positron emission tomography, R-CHOP = cyclophosphamide, doxorubicin, vincristine, prednisolone, rituximab

Reference

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