Distal appendicular skeletal involvement of diffuse large B-cell lymphoma on technetium-99m methylenediphosphonate bone scintigraphy and 18F-fluorodeoxyglucose positron emission tomography/computed tomography: a case report

Abstract

BackgroundWe report a case of a patient with appendicular bone involvement of diffuse large B-cell lymphoma visualized by whole-body technetium-99m methylenediphosphonate bone scintigraphy (bone scan) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Case presentationA 73-year-old Asian man who had gingival swelling of the labial area of the left maxillary lateral incisor presented to our institution. Positron emission tomography/computed tomography demonstrated hypermetabolic lesions with maximum standardized uptake values of 12.15 in the left testis, 1.92 in the skin of the right chest, and 2.88 in the left ulna and third metatarsal bone. A bone scan showed multiple uptakes in the left ulna, hand, both tibiae, and the left foot. We diagnosed the tumor as diffuse large B-cell lymphoma by excision. Magnetic resonance imaging showed enhanced signaling of lesions with soft tissue edema in the olecranon of the left ulna, the third metacarpal bone of the left hand, and the third metatarsal bone of the left foot. Magnetic resonance imaging findings prompted a diagnosis of lymphoma. Eight cycles of chemotherapy plus external radiotherapy targeted to the involved bone sites were given for 5 months. Follow-up positron emission tomography/computed tomography and bone scanning revealed the disappearance of hypermetabolism and decreased uptake in lesions compared with the previous images. Laboratory data were also all within the normal limits after chemotherapy.ConclusionsThis report highlights that appendicular bone involvement of diffuse large B-cell lymphoma can be detected on whole-body bone scans and by positron emission tomography/computed tomography.

Unusual presentation of diffuse large B-cell lymphoma involving the calcaneus: A case report

“…There are many non-specific symptoms associated with DLBCL that vary from mild general pain to soft tissue swelling, sometimes with systemic symptoms also known as B symptoms (fever, night sweats and unintentional weight loss). According to Park et al, bones that are involved with DLBCL include the femur (27%), pelvis (15%), tibia/fibula (13%), humerus (12%), spine (9%), mandible (2%), radius/ulna (1%), scapula (1%), skull (1%) and bones of the hands and feet were uncommonly involved 8 . Lymphoma can infiltrate any organ in the body including bone with bone marrow involvement present in approximately 50% to 80% of patients with low grade NHL and 25% to 40% of those with high-grade NHL 9,10 .…”

Gastrointestinal tract metastasis of mandibular diffuse large B‐cell lymphoma

“…Additionally, it is indicated to take a bone scan, after detection of clinical signs of osseous involvement through the mandible CT . Whole‐body bone scans and positron emission tomography/computed tomography (PET/CT) should be preferred for detection of the appendicular bone involvement of DLBCL …”