Header
Clinical Image
Exophytic Lymphoma of the Uterus Identified by 18-FDG PET Scan
Partha Sinha1*, Rashmi T. Nair1, Halemane Ganesh1, Matthew S.Purdom2, Steven J. Krohmer1 and Gary R. Conrad1
1Department of Radiology, University of Kentucky, USA
2Department of Pathology, University of Kentucky, USA

CLINICAL IMAGE
A 56 year old woman with stage IV follicular lymphoma presenting with bilateral axillary and inguinal lymphadenopathy seven years back was treated by chemotherapy at an outside institution and had been in remission since past five years. She then presented with a right groin mass, which on excisional biopsy was reportedly positive for lymphoma. PET/CT scan performed in a Siemens Biograph 6 after 70 minutes of incubation following the intravenous administration of 13.2 mCi 18-F fluorodeoxyglucose (FDG) with a blood glucose of 100 mg/dl showed an intensely hypermetabolic 4.9 x 4.3 x 4.2 cm exophytic mass with a maximum SUV of 31.4 arising from the uterine fundus. No other hypermetabolic abnormalities were identified in the PET/CT scan (Figure 1).
Figure 1 PET/CT scan obtained with 18-F FDG demonstrates a hypermetabolic pelvic mass.

Figure 1

PET/CT scan obtained with 18-F FDG demonstrates a hypermetabolic pelvic mass.

×
Figure 2 The CT guided FNA showed sheets of dyshesive large cells with irregular nuclear membranes, coarse chromatin and prominent nucleoli. Flow cytometry on the aspirate demonstrated a kappa clonal population of CD10 positive B cells (positive for CD19, CD20, CD38, FMC 7, and dim partial CD23,negative for CD5). The morphologic and immunophenotypic findings support the diagnosis of large B cell lymphoma, and given the history of follicular lymphoma and the CD10 positivity of the large cells in this specimen, the findings are most consistent with a transformation from the patient's previously identified lymphoma.

Figure 2

The CT guided FNA showed sheets of dyshesive large cells with irregular nuclear membranes, coarse chromatin and prominent nucleoli. Flow cytometry on the aspirate demonstrated a kappa clonal population of CD10 positive B cells (positive for CD19, CD20, CD38, FMC 7, and dim partial CD23,negative for CD5). The morphologic and immunophenotypic findings support the diagnosis of large B cell lymphoma, and given the history of follicular lymphoma and the CD10 positivity of the large cells in this specimen, the findings are most consistent with a transformation from the patient's previously identified lymphoma.

×
The role of 18-F FDG PET/CT scans in the diagnosis and staging of lymphomas is well established in the literature [1]. Uterine lymphomas are rare tumors [2-8]. The cases described in the literature have typically demonstrated, diffuse or focal involvement of the uterus, intravascular involvement or presentation as an endometrial polyp. Exophytic appearance of uterine lymphomas appears to be unusual. Hypermetabolism in the uterus can be identified in various conditions such as menstruation, post partum status or lymphomas [9]. This case illustrates the importance of including exophytic lymphomas of the uterus in the differential of pelvic hypermetabolic masses.
Figure 3 Follow up CT scan (B) obtained 3 months later following external beam radiotherapy 4500 cGy in 20 fractions shows the uterine mass to have responded and be significantly smaller at 1.5 x 1.1 x 1.6 cm as compared to the pre-therapy scan (A).

Figure 3

Follow up CT scan (B) obtained 3 months later following external beam radiotherapy 4500 cGy in 20 fractions shows the uterine mass to have responded and be significantly smaller at 1.5 x 1.1 x 1.6 cm as compared to the pre-therapy scan (A).

×

References
  1. Ansell SM, Armitage JO. Positron emission tomographic scans in lymphoma: convention and controversy. Mayo Clin Proc. 2012; 87:571-580.
  2. Alvarez A, Ortiz JA, Sacristán F. Large B-cell lymphoma of the uterine corpus: case report with immunohistochemical and molecular study. Gynecol Oncol. 1997; 65: 534-538.
  3. Binesh F, Karimi zarchi M, Vahedian H, Rajabzadeh Y. Primary malignant lymphoma of the uterine cervix. BMJ Case Rep. 2012; 2012.
  4. Koliopoulos G, Parkin D, Paraskevaidis E. A case of B-cell lymphoblastic lymphoma involving the uterus. Eur J Gynaecol Oncol. 2002; 23: 113-114.
  5. Lannoo L, Smets S, Steenkiste E, Delforge M, Moerman P, Stroobants S, et al. Intravascular large B-cell lymphoma of the uterus presenting as fever of unknown origin (FUO) and revealed by FDG-PET. Acta Clin Belg. 2007; 62: 187-190.
  6. Rittenbach J, Cao JD, Weiss LM, Rowsell EH, Chick W, Wang J. Primary diffuse large B-cell lymphoma of the uterus presenting solely as an endometrial polyp. International journal of gynecological pathology:official. Journal of the International Society of Gynecological Pathologists. 2005; 24: 347-351.
  7. Upanal N, Enjeti A. Primary lymphoma of the uterus and cervix: two case reports and review of the literature. Aust N Z J Obstet Gynaecol. 2011; 51: 559-562.
  8. Samama M, van Poelgeest M. Primary malignant lymphoma of the uterus: a case report and review of the literature. Case Rep Oncol. 2011; 4: 560-563.
  9. Zhuang H, Yamamoto AJ, Sinha P, Pourdehnad M, Liu Y, Alavi A. Similar pelvic abnormalities on FDG positron emission tomography of different origins. Clin Nucl Med. 2001; 26: 515-517.

Cite this article: Sinha P, Nair RT, Ganesh H, Purdom MS, Krohmer SJ, et al. (2013) Exophytic Lymphoma of the Uterus Identified by 18-FDG PET Scan. J Radiol Radiat Ther 1(2): 1014.
Right Table
Footer
Content:   Home  |  Aims & Scope  |  Early Online  |  Current Issue  | 
Journal Info:   Editorial Board  |  Article Processing Charges  |  FAQs
Contact Us
2952 Market Street, Suite 140
San Diego, California 92102, USA
Tel: 1-619-373-8030
Fax: 1-619-793-4845
Toll free number: 1-800-762-9856
Copyright © 2013 JSciMed Central. All rights reserved.