Journal of Medical Case Reports | |
Heterogeneous bone marrow uptake on interim 18F-fluorodeoxyglucose positron emission tomography for lymphoma mimicking disease progression: a case report | |
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 |
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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.
【 预 览 】
Files | Size | Format | View |
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20150514103831903.pdf | 1575KB | download | |
Figure 3. | 67KB | Image | download |
Figure 2. | 56KB | Image | download |
Figure 1. | 61KB | Image | download |
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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.