Presentation
Epigastric pain. On US, epigastric mass was noted.
Patient Data
Age: 75 years
Gender: Male
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Lymph nodes:
FDG avid multiple pathologically enlarged lymph nodes seen at:
- bilateral supraclavicular lymph nodes, largest and most active on the left with SUV max 10.
- mediastinal lymph nodes: superior mediastinal retrosternal, pretracheal, right paratracheal, right tracheobronchial, right carinal, and bilateral retrocrural lymph nodes
- abdominal lymph nodes: left gastric, celiac, left para-aortic, porta hepatis, portocaval, aortocaval and left common iliac lymph nodes. SUV max 13.12 as measured over 3.2 cm left para-aortic nodes.
Osseous:
- increased FDG uptake by the right scapula, pelvic bones, and sacral lytic lesions. SUV max 16.08 as measured over left iliac bone
Thyroid
- increased FDG uptake by the nodular enlarged thyroid gland with left lobe retrosternal extension (SUV max 3.38 on the left lobe), likely multinodular goiter, for further assessment
From the case:
Lymphoma (PET-CT)
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Epigastric tru cut nodal biopsy showed dense lymphoid infiltrate.
Case Discussion
The case demonstrates multiple nodal and osseous neoplastic lesions, with no evidence of another primary tumor elsewhere, hence lymphoma was considered, which was pathologically proven.
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