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Journal of Medical Case Reports

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Open Access 01-12-2014 | Case report

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

Authors: Martin H Cherk, Sushrut Patil, Paul Beech, Victor Kalff

Published in: Journal of Medical Case Reports | Issue 1/2014

Abstract

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.

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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. 10.1007/s12149-011-0549-0.CrossRefPubMed

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.CrossRefPubMed

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. 10.1182/blood-2005-06-2252.CrossRefPubMed

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. 10.1002/cncr.22276.CrossRefPubMed

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. 10.1016/j.ejca.2010.12.027.CrossRefPubMed

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. 10.1016/j.bbmt.2008.11.026.CrossRefPubMedPubMedCentral

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. 10.1097/CCO.0b013e3282f5123d.CrossRefPubMedPubMedCentral

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. 10.3109/10428194.2013.862242.CrossRefPubMed

Avigdor A: Staging DLBCL: bone marrow biopsy or PET-CT?. Blood. 2013, 122: 4-5. 10.1182/blood-2013-05-502575.CrossRefPubMed

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. 10.2967/jnumed.112.114710.CrossRefPubMed

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. 10.1097/01.rlu.0000246858.03018.0c.CrossRefPubMed

13.

Barrington S: Atlas of Clinical Positron Emission Tomography. 2013, United States of America: CRC Press, 2

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. 10.1007/s00277-011-1353-6.CrossRefPubMed

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. 10.1097/MNM.0b013e328363c695.CrossRefPubMed

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.PubMed

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. 10.1007/s00259-010-1531-0.CrossRefPubMed

Title: Heterogeneous bone marrow uptake on interim 18F-fluorodeoxyglucose positron emission tomography for lymphoma mimicking disease progression: a case report
Authors: Martin H Cherk
Sushrut Patil
Paul Beech
Victor Kalff
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2014
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/1752-1947-8-362

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Introduction

Case presentation

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Case presentation

Conclusions

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