An unusual presentation of recurrent T cell lymphoma: angiocentric pattern of cutaneous uptake on [ 18 F]FDG PET/CT
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IMAGE OF THE MONTH
An unusual presentation of recurrent T cell lymphoma: angiocentric pattern of cutaneous uptake on [18F]FDG PET/CT Kip E. Guja 1 & Ryanne Brown 2 & Brad Girod 3 & Hong Song 1 & Caitlyn Harrison 1 & Benjamin L. Franc 1 & Farshad Moradi 1 & Guido Davidzon 1 & Andrei Iagaru 1 & Carina Mari Aparici 1 Received: 15 July 2020 / Accepted: 31 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Introduction and discussion Cutaneous T cell lymphomas have been recognized for over 200 years and since then have continued to fascinate scientists because of the unique propensity of T cells to proliferate only in the skin [1]. Angiocentric T cell lymphoma is a rare type of cutaneous lymphoma with an incidence rate of 0.036 per 100,000 persons [2, 3]. We present images of a 63-year-old male with T cell lymphoma who underwent induction chemotherapy and immunotherapy followed by autologous bone marrow transplant with complete metabolic response on post-treatment [18F]FDG-PET/CT approximately 14 months after his initial treatment began (attenuation-corrected maximum intensity projection image shown in panel a). The patient subsequently presented 1 month later with diffuse rash, leukocytosis, and AKI, prompting concern for recurrence. Dermatology was consulted for skin biopsy, and peripheral blood flow cytometry was performed, revealing evidence
of recurrent T cell lymphoma. An [18F]FDG-PET/CT for restaging demonstrated a cutaneous pattern of FDG uptake (panel b) that localized to the skin (particularly the anterior chest, upper abdomen, and scrotum) as seen on axial PET (panel c, indicated with arrows) and PET/CT fused images (panel D) which correlated with a reticular purpuric rash seen on physical exam (panel e). Skin biopsy results revealed T cell lymphoma with cutaneous involvement in an angiocentric pattern, with abnormal cells clustering around vessels (panels f–g, star indicates a vessel), which mimicked the imaging and physical exam findings. Histology showed no evidence of vascular damage, vasculitis, or graft versus host disease, which are other etiologies that could cause a similar rash. The patient was treated with chemotherapy, discharged to hospice, and expired approximately 2 weeks later.
Kip E. Guja, Ryanne Brown and Brad Girod contributed equally to this work. This article is part of the Topical Collection on Image of the month * Carina Mari Aparici [email protected] 1
Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
2
Departments of Pathology and Dermatology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
3
School of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
Compliance with ethical standards All authors declare no conflicts of interest. Given that the patient is deceased, informed consent could not be obtained. Accordingly, the case description has been anonymized to protect the patient’s identity.
Eur J Nuc
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