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CT, MRI, and 18 F-FDG PET/CT Findings in Untreated Pulmonary and Hepatic B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Over a Five-Year Period

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ABSTRACT

Imaging findings of hepatic lymphoma of mucosa-associated lymphoid tissue (MALT) have been rarely reported before. We present the computed tomography (CT), magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT findings in a patient with untreated pulmonary and hepatic MALT lymphoma over a 5-year period.

On the 1st abdominal MRI scan, the hepatic MALT lymphoma showed multiple hepatic subcapsular masses. On FDG PET/CT, these hepatic tumors showed hypodenisty with FDG uptake similar to the liver on early PET images, and higher than liver on delayed PET images. The patient declined to undergo treatment. Fiver year later, the follow-up MRI and FDG PET/CT showed enlargement and confluence of the hepatic tumors with higher FDG uptake than before. The enlarged hepatic tumors had minimal mass effect. In the hepatic lesions, the blood vessels and bile ducts had no distortion or displacement.

The hepatic MALT lymphoma should be taken into consideration when the hepatic tumors have minimal mass effect with the intrahepatic blood vessels and bile ducts normally passing through the tumors. Delayed-time-point FDG PET/CT imaging may be helpful for improving detectability of the hepatic MALT lymphoma.

No MeSH data available.


Related in: MedlinePlus

MIP PET (A), transverse CT (B–D), and corresponding fused (E–G) images showed increased FDG uptake of the enlarged pulmonary (SUVmax, 5.4) and hepatic (SUVmax, 4.3) lesions, and bilateral parotid (arrows) (SUVmax, 3.6) and submaxillary (arrowheads) (SUVmax, 4.1) glands. CT = computed tomography, FDG = fluorodeoxyglucose, MIP = maximum intensity projection, PET = positron emission tomography, SUVmax = maximum standard uptake value.
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Figure 5: MIP PET (A), transverse CT (B–D), and corresponding fused (E–G) images showed increased FDG uptake of the enlarged pulmonary (SUVmax, 5.4) and hepatic (SUVmax, 4.3) lesions, and bilateral parotid (arrows) (SUVmax, 3.6) and submaxillary (arrowheads) (SUVmax, 4.1) glands. CT = computed tomography, FDG = fluorodeoxyglucose, MIP = maximum intensity projection, PET = positron emission tomography, SUVmax = maximum standard uptake value.

Mentions: A 52-year-old female was referred because of 1-month history of chest discomfort. Laboratory tests showed normal a-fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19–9, and carbohydrate antigen 125 levels. Serum hepatitis B virus surface antigen was positive. Chest radiograph and enhanced CT showed multiple peripheral consolidations of the bilateral lungs (Figure 1). CT also showed diffuse right lung-predominant micronodules with peribronchovascular and subpleural distribution (Figure 1). Upper abdominal MRI scan showed multiple hepatic subcapsular masses (Figure 2). These masses showed isointensity on dynamic enhanced MRI. Fluorodeoxyglucose (FDG) PET/CT was performed for further elevation of the patient. Early FDG PET/CT scan (performed 1 hour after injection of tracer) showed increased FDG uptake of the multiple pulmonary consolidations (Figure 3A) with maximum standard uptake value (SUVmax) of 5.4. The FDG uptake of hepatic masses (SUVmax, 3.5) was similar to the surrounding hepatic parenchyma. The bilateral parotid (SUVmax, 1) and submaxillary (SUVmax, 2.5) glands were normal. On delayed FDG PET/CT scan (performed 2 hours after injection of tracer), the SUVmax of the hepatic masses increased to 4.4. Biopsies of the right pulmonary and hepatic lesions revealed small B-cell lymphocytic hyperplasia in the pulmonary and hepatic parenchyma. B-cell lymphoma was suspected. But the patient declined to undergo any future examination and treatment. Five years later, she complained of cough lasting for 20 days. A chest CT was performed showing enlargement of the pulmonary consolidations (Figure 4A–C). Abdominal MRI showed significant enlargement of the hepatic lesions with minimal mass effect (Figure 4D–F). In the hepatic lesions, the blood vessels and bile ducts had no distortion or displacement. FDG PET/CT scan (performed 1 hour after injection of tracer) showed increased FDG uptake of the pulmonary (SUVmax, 5.4) and hepatic (SUVmax, 4.3) lesions, and bilateral parotid (SUVmax, 3.6) and submaxillary (SUVmax, 4.1) glands (Figure 5).


CT, MRI, and 18 F-FDG PET/CT Findings in Untreated Pulmonary and Hepatic B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) Over a Five-Year Period
MIP PET (A), transverse CT (B–D), and corresponding fused (E–G) images showed increased FDG uptake of the enlarged pulmonary (SUVmax, 5.4) and hepatic (SUVmax, 4.3) lesions, and bilateral parotid (arrows) (SUVmax, 3.6) and submaxillary (arrowheads) (SUVmax, 4.1) glands. CT = computed tomography, FDG = fluorodeoxyglucose, MIP = maximum intensity projection, PET = positron emission tomography, SUVmax = maximum standard uptake value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998414&req=5

Figure 5: MIP PET (A), transverse CT (B–D), and corresponding fused (E–G) images showed increased FDG uptake of the enlarged pulmonary (SUVmax, 5.4) and hepatic (SUVmax, 4.3) lesions, and bilateral parotid (arrows) (SUVmax, 3.6) and submaxillary (arrowheads) (SUVmax, 4.1) glands. CT = computed tomography, FDG = fluorodeoxyglucose, MIP = maximum intensity projection, PET = positron emission tomography, SUVmax = maximum standard uptake value.
Mentions: A 52-year-old female was referred because of 1-month history of chest discomfort. Laboratory tests showed normal a-fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19–9, and carbohydrate antigen 125 levels. Serum hepatitis B virus surface antigen was positive. Chest radiograph and enhanced CT showed multiple peripheral consolidations of the bilateral lungs (Figure 1). CT also showed diffuse right lung-predominant micronodules with peribronchovascular and subpleural distribution (Figure 1). Upper abdominal MRI scan showed multiple hepatic subcapsular masses (Figure 2). These masses showed isointensity on dynamic enhanced MRI. Fluorodeoxyglucose (FDG) PET/CT was performed for further elevation of the patient. Early FDG PET/CT scan (performed 1 hour after injection of tracer) showed increased FDG uptake of the multiple pulmonary consolidations (Figure 3A) with maximum standard uptake value (SUVmax) of 5.4. The FDG uptake of hepatic masses (SUVmax, 3.5) was similar to the surrounding hepatic parenchyma. The bilateral parotid (SUVmax, 1) and submaxillary (SUVmax, 2.5) glands were normal. On delayed FDG PET/CT scan (performed 2 hours after injection of tracer), the SUVmax of the hepatic masses increased to 4.4. Biopsies of the right pulmonary and hepatic lesions revealed small B-cell lymphocytic hyperplasia in the pulmonary and hepatic parenchyma. B-cell lymphoma was suspected. But the patient declined to undergo any future examination and treatment. Five years later, she complained of cough lasting for 20 days. A chest CT was performed showing enlargement of the pulmonary consolidations (Figure 4A–C). Abdominal MRI showed significant enlargement of the hepatic lesions with minimal mass effect (Figure 4D–F). In the hepatic lesions, the blood vessels and bile ducts had no distortion or displacement. FDG PET/CT scan (performed 1 hour after injection of tracer) showed increased FDG uptake of the pulmonary (SUVmax, 5.4) and hepatic (SUVmax, 4.3) lesions, and bilateral parotid (SUVmax, 3.6) and submaxillary (SUVmax, 4.1) glands (Figure 5).

View Article: PubMed Central - PubMed

ABSTRACT

Imaging findings of hepatic lymphoma of mucosa-associated lymphoid tissue (MALT) have been rarely reported before. We present the computed tomography (CT), magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT findings in a patient with untreated pulmonary and hepatic MALT lymphoma over a 5-year period.

On the 1st abdominal MRI scan, the hepatic MALT lymphoma showed multiple hepatic subcapsular masses. On FDG PET/CT, these hepatic tumors showed hypodenisty with FDG uptake similar to the liver on early PET images, and higher than liver on delayed PET images. The patient declined to undergo treatment. Fiver year later, the follow-up MRI and FDG PET/CT showed enlargement and confluence of the hepatic tumors with higher FDG uptake than before. The enlarged hepatic tumors had minimal mass effect. In the hepatic lesions, the blood vessels and bile ducts had no distortion or displacement.

The hepatic MALT lymphoma should be taken into consideration when the hepatic tumors have minimal mass effect with the intrahepatic blood vessels and bile ducts normally passing through the tumors. Delayed-time-point FDG PET/CT imaging may be helpful for improving detectability of the hepatic MALT lymphoma.

No MeSH data available.


Related in: MedlinePlus