Presentation
Painless left arm non-pitting edema and axillary mass. History of diffuse large B-cell lymphoma, currently in remission.
Patient Data
There are multiple FDG-avid axillary lymph nodes bilaterally. There are FDG-avid but non-enlarged mediastinal and left internal thoracic lymph nodes. No abnormal FDG uptake is seen within the lungs. There are multiple FDG-avid para-aortic, mesenteric, bilateral pelvic (including mesorectal) and bilateral inguinal lymph nodes, many of which are significantly enlarged on CT. An FDG-avid gluteal node is noted. The spleen shows mild diffusely increased FDG uptake with no focal lesion or enlargement.
Left axillary node: 41 x 33 mm, left external iliac node: 38 x 26 mm, right external iliac node: 59 x 28 mm, right inguinal node: 38 x 28 mm.
Case Discussion
This is a case of relapsed non-Hodgkin lymphoma (NHL) on PET-CT presenting as diffuse, painless non-pitting left arm edema. Core biopsy was not definitive for diffuse large B-cell lymphoma (DLBCL) relapse, as it showed CD5 positivity, whereas previous DLBCL was CD5 negative. Palliative chemotherapy was commenced to reduce the disease burden.
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