Heterogeneous bone marrow uptake on interim 18F-fluorodeoxyglucose positron emission tomography for lymphoma mimicking disease progression: a case report

Journal of Medical Case Reports

Victor Kalff¹  Paul Beech³  Sushrut Patil²  Martin H Cherk¹ 

[1] Department of Medicine, Monash University Melbourne, Central Clinical School Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia;Department of Hematology, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia;Department of Nuclear Medicine, The Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia

关键词: Pegfilgrastim;    Granulocyte colony stimulating factor;    Positive;    False;    Response;    Chemotherapy;    PET;    FDG;    Lymphoma;   

Others  :  1180991
DOI  :  10.1186/1752-1947-8-362

 received in 2014-05-26, accepted in 2014-09-01,  发布年份 2014

【 摘 要 】

Introduction

The use of ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) scanning for baseline staging and assessment of treatment response for higher grade lymphomas is considered to be the standard of care. Evaluation of lymphomatous bone marrow infiltration on ¹⁸F-FDG PET can usually distinguish between normal regenerating marrow following chemotherapy by a characteristic pattern of uptake.

Case presentation

Here we report the case of a 51-year-old Caucasian woman with mixed low- and high-grade lymphoma with biopsy confirmed marrow infiltration. An interim post-three cycle chemotherapy ¹⁸F-FDG PET scan revealed apparent progression of marrow disease. Subsequent investigations were performed including bone marrow biopsies, repeat ¹⁸F-FDG PET scanning and a white cell scan. These revealed the interim ¹⁸F-FDG PET scan appearance was due to a highly unusual pattern of scattered islands of regenerating normal marrow, rather than progressive lymphoma.

Conclusions

Our case report highlights that apparent severe bone marrow abnormalities on ¹⁸F-FDG PET scans in lymphoma patients treated with chemotherapy are not always due to disease. Clinicians should retain a high index of suspicion for benign causes when ¹⁸F-FDG PET scan results appear incongruent with clinical response.

【 授权许可】

   
2014 Cherk et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Baba S, Abe K, Isoda T, Maruoka Y, Sasaki M, Honda H: Impact of FDG-PET/CT in the management of lymphoma. Ann Nucl Med 2011, 25:701-716.
• [2]Dunleavy K, Mikhaeel G, Sehn LH, Hicks RJ, Wilson WH: The value of positron emission tomography in prognosis and response assessment in non-Hodgkin lymphoma. Leuk Lymphoma 2010, 51(Suppl 1):28-33.
• [3]Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, Buus S, Keiding S, D'Amore F, Boesen AM, Berthelsen AK, Specht L: FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 2006, 107:52-59.
• [4]Kostakoglu L, Goldsmith SJ, Leonard JP, Christos P, Furman RR, Atasever T, Chandramouly A, Verma S, Kothari P, Coleman M: FDG-PET after 1 cycle of therapy predicts outcome in diffuse large cell lymphoma and classic Hodgkin disease. Cancer 2006, 107:2678-2687.
• [5]Yang DH, Min JJ, Song HC, Jeong YY, Chung WK, Bae SY, Ahn JS, Kim YK, Bom HS, Chung IJ, Kim HJ, Lee JJ: Prognostic significance of interim (1)(8)F-FDG PET/CT after three or four cycles of R-CHOP chemotherapy in the treatment of diffuse large B-cell lymphoma. Eur J Cancer 2011, 47:1312-1318.
• [6]Kasamon YL, Wahl RL, Ziessman HA, Blackford AL, Goodman SN, Fidyk CA, Rogers KM, Bolanos-Meade J, Borowitz MJ, Ambinder RF, Jones RJ, Swinnen LJ: Phase II study of risk-adapted therapy of newly diagnosed, aggressive non-Hodgkin lymphoma based on midtreatment FDG-PET scanning. Biol Blood Marrow Transplant 2009, 15:242-248.
• [7]Kasamon YL, Wahl RL: FDG PET and risk-adapted therapy in Hodgkin's and non-Hodgkin's lymphoma. Curr Opin Oncol 2008, 20:206-219.
• [8]Stewart DA, Kloiber R, Owen C, Bahlis NJ, Duggan P, Mansoor A, Bence-Bruckler I: Results of a prospective phase II trial evaluating interim positron emission tomography-guided high dose therapy for poor prognosis diffuse large B-cell lymphoma. Leuk Lymphoma 2014, 55:2064-2070.
• [9]Avigdor A: Staging DLBCL: bone marrow biopsy or PET-CT? Blood 2013, 122:4-5.
• [10]Berthet L, Cochet A, Kanoun S, Berriolo-Riedinger A, Humbert O, Toubeau M, Dygai-Cochet I, Legouge C, Casasnovas O, Brunotte F: In newly diagnosed diffuse large B-cell lymphoma, determination of bone marrow involvement with 18F-FDG PET/CT provides better diagnostic performance and prognostic stratification than does biopsy. J Nucl Med 2013, 54:1244-1250.
• [11]Tang B, Patel MM, Wong RH, Wood D, Wong CO, Wu D, Khong PL, Wong CY: Revisiting the marrow metabolic changes after chemotherapy in lymphoma: a step towards personalized care. Int J Mol Imag 2011, 2011:942063.
• [12]Lin EC: FDG PET/CT flip flop phenomenon in treated lymphoma of bone. Clin Nucl Med 2006, 31:803-805.
• [13]Barrington S: Atlas of Clinical Positron Emission Tomography. 2nd edition. United States of America: CRC Press; 2013.
• [14]Hong J, Lee Y, Park Y, Kim SG, Hwang KH, Park SH, Jeong J, Kim KH, Ahn JY, Park S, Park J, Lee JH: Role of FDG-PET/CT in detecting lymphomatous bone marrow involvement in patients with newly diagnosed diffuse large B-cell lymphoma. Ann Hematol 2012, 91:687-695.
• [15]Gonzalez-Barca E, Canales M, Cortes M, Vidal MJ, Salar A, Oriol A, Bargay J, Bello JL, Sanchez JJ, Tomas JF, Donato E, Ferrer S, Caballero D: Predictive value of interim (1)(8)F-FDG-PET/CT for event-free survival in patients with diffuse large B-cell lymphoma homogenously treated in a phase II trial with six cycles of R-CHOP-14 plus pegfilgrastim as first-line treatment. Nucl Med Commun 2013, 34:946-952.
• [16]Jacene HA, Ishimori T, Engles JM, Leboulleux S, Stearns V, Wahl RL: Effects of pegfilgrastim on normal biodistribution of 18F-FDG: preclinical and clinical studies. J Nucl Med 2006, 47:950-956.
• [17]Agool A, Glaudemans AW, Boersma HH, Dierckx RA, Vellenga E, Slart RH: Radionuclide imaging of bone marrow disorders. Eur J Nucl Med Mol Imaging 2011, 38:166-178.