Hodgkin lymphoma (HL) and Non-Hodgkin lymphoma (NHL) are the malignant neoplasm spectrum originating from the lymphoid system and constituting 8% of all malignancies. Although, both are known as primary malignancies of lymph nodes, extranodal involvement can be seen. In this case presentation, in addition to nodal and bone involvement areas in a patient diagnosed as marginal zone lymphoma, rare simultaneous testicular and skin extranodal involvement detected on 18F-FDG PET-CT imaging were presented.
rare skin, testicular extranodal, PET-CT imaging, marginal zone lymphoma, nuclear medicine, Hodgkin lymphoma, Non-Hodgkin lymphoma
Hodgkin lymphoma-HL, Non-Hodgkin lymphoma-NHL, Marginal zone lymphomas-MZL
Extranodal involvement areas such as gastrointestinal, head and neck, orbital, central and peripheral nervous system, thorax, bone, skin, breast, testis, thyroid and genitourinary system can be seen in 25-40% of HL and especially NHL patients, although it is known as lymph node malignancy [1,2]. Extranodal involvement is important in terms of prognosis and imaging procedures play a very important role in diagnosis. 18F-FDG PET-CT imaging is a standard method in lymphoma patients and has a special importance in these patients in terms of superiority of CT imaging in detecting extranodal regions. The role of 18F-FDG PET-CT in detection, staging and restaging of patients with extranodal involvement in NHL has also been reported in the literature [3,4]. In this case presentation, in addition to nodal and bone involvement areas in a patient diagnosed as marginal zone lymphoma, rare testicular and skin extranodal simultaneous involvement detected on 18F-FDG PET-CT imaging were presented.
A 72-year-old male patient diagnosed as marginal zone lymphoma following mass excision from the left thoracic cage underwent 18F-FDG PET-CT imaging for initial staging. PET-CT images showed hypermetabolic (SUVmax: 14.66-31.89) conglomereted lymphadenopathies in the bilateral cervical chain, supraclavicular area, bilateral axillary, mediastinal, retroperitoneal, paraaortic, peripancreatic, perigastric, liver hilum, paracoeliac regions, pericardial thickening-effusion and hypermetabolic (SUVmax: 3.32-12.83) bone lesions. Additionally, multiple subcutaneous hypermetabolic (SUVmax: 10.5-24.37) nodules were detected at various levels within the cross-sectional area. In addition; Testis lymphoma FDG uptake (SUVmax: 20.26) was noted in the right hemiscrotum (Figure 1). Testis lymphoma has been proved by excisional biopsy.
Figure 1. 18F-FDG PET-CT Image showing the spread of Lymphoma.
Marginal zone lymphomas (MZL) are defined as a heterogeneous group of lymphomas although, can originate from the spleen, lymph nodes and extra-nodal lymphoid tissue, termed as "marginal zone" and formed of B-lymphocytes. Testicular involvement is a very rare entity. Testicular lymphoma can be primary or secondary to extensive disease. Inguinal and retroperitoneal lymph nodal spread can also be seen in some patients . In our case, there was abnormally increased asymmetric FDG uptake in the enlarged right testis. Also, multiple para-aortic lymph nodes showed abnormal FDG accumulation, as if spreading from involved testis by lymphomatous way. Yin et al. reported a case of a 55-year-old man with NHL of the left testis and of the bilateral adrenals detected by 18F-FDG PET-CT and demonstrated its role in the diagnosis and assessment of therapeutic response . Multiple isolated cases with extranodal involvement of NHL, detected on PET-CT, have been previously reported [5-8]. In this case report, in addition to nodal involvement areas in a patient diagnosed as marginal zone lymphoma, rare areas of testicular and skin extranodal involvement detected by 18F-FDG PET-CT imaging is presented. Patients with abnormal testicular involvement should undergo further examination and confirmation of the finding is necessary.
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