Disseminated diffuse large B cell lymphoma of bone on PET scan

Excerpt

On January 2006, a 33-year-old previously-healthy male was admitted to the hospital with a three-year history of intermittent low back pain and radiating to bilateral lower legs along anterior thighs. Physical examination revealed weakness of bilateral legs with paresthesias and diminished deep tendon reflex. Physically, there was neither hepatosplenomegaly nor lymphadenopathy. There was no illicit drug use, exposure to environmental toxins, recent traveling or traumatic history. His family history was noncontributory. Magnetic resonance image of spine (Fig. 1) showed diffuse heterogeneous enhancing lesions over whole spine including cervical, thoracic, and lumbar spines. The histopathology of bone marrow biopsy (Fig. 2) revealed diffuse large B cell lymphoma with positive for CD20. A staging ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) (Fig. 3) demonstrated disseminated ¹⁸F-FDG uptake lesions over the bone of whole body, including skull, whole spines, pelvis, upper limbs and lower limbs. The liver and spleen also showed multiple lesions. He received eight courses of chemotherapy with rituximab, cyclophosphamide, adriamycin, oncovin and prednisolone (R-CHOP), followed by high-dose chemotherapy combined with autologous peripheral blood stem cell transplantation. The following PET scan (Fig. 4) showed no evidence of abnormal FDG uptake throughout whole body region. The patient remained in complete remission at 10 months.

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