Unexplained systemic symptoms and Gallium-67--guided decisions.
Over 3 months, a healthy man developed prominent systemic symptoms that defied investigation. Physical examination was noncontributory, and extensive studies revealed only a marked acute-phase response associated with increased serum IL-6 levels. A whole body Gallium-67 scan was crucial in diagnosis, directing attention to high uptake in the left paraspinal and psoas muscles. Open surgical excision biopsy was performed, guided by intraoperative use of a gamma-probe. Removed tissue was diagnosed as diffuse, large B-cell non-Hodgkin lymphoma of muscle (stage IE), a rare extranodal lymphoma. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy was given, and the patient became asymptomatic with normal blood tests and was thought to be in remission. However, a repeat Gallium-67 scan revealed recurrent multifocal disease and salvage chemotherapy was instituted. A 47,XXY karyotype (Klinefelter syndrome) was later identified, possibly associated with the lymphoma.
Department of Medicine, Kaplan Medical Center, Rehovot, Israel. amimd@clalit.org.il
A
A
Schattner
A
A
Cohen
L
L
Wolfson
M
M
Melloul
D000383:Agriculture; D003937:Diagnosis, Differential; D005710:Gallium Radioisotopes; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016658:Psoas Muscles / Q000473:pathology / Q000601:surgery; D011877:Radionuclide Imaging; D000078329:Workforce
D005710:Gallium Radioisotopes; D015850:Interleukin-6