Relapsed non-Hodgkin lymphoma

Case contributed by Dr Vijay Mistry

Presentation

Painless left arm non-pitting edema and axillary mass. History of diffuse large B-cell lymphoma, currently in remission.

Patient Data

Age: 90 years
Gender: Male

FDG PET/CT

Nuclear medicine

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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