FDG-PET detection of primary bone marrow large B-cell lymphoma in a patient with hairy cell leukemia.
We describe a case of hairy cell leukaemia (HCL) coexistent with non-Hodgkin's lymphoma (NHD). This combination is reported to be extremely rare with no clear demonstration of the clonal relationship between the two conditions. After a previous failure of purine analogue therapy, our patient was successfully treated with rituximab resulting in normalisation of blood cell count cessation of blood transfusion and negative iliac crest biopsy. Unfortunately, the patient developed intense and persistent bone pain during the 1(st) line treatment for HCL. Skeletal X-rays, neck-thorax-abdomen CT scan and repeated bone MRI were unremarkable and bone scintigraphy showed non-specific changes. Laboratory examinations were normal. To better evaluate bone scintigraphy results, we finally performed FDG-PET/CT, which showed multiple foci of intense abnormal radiotracer uptake involving the bone marrow. An FDG-PET/CT guided bone marrow biopsy showed primary bone marrow diffuse large B-cell lymphoma (LBCL). Despite 2(nd) and 3(rd) line treatment, the patient died shortly after for central nervous system involvement by NHD. The role of FDG-PET/CT in identifying bone and bone marrow localization of NHD is reviewed and an earlier use is suggested in poorly understood bone pain.
Paolini
Rossella
R
Onco-Haemathology Service, S.Maria della Misericordia Rovigo Hospital, Rovigo, Italy.
Bianchini
Enzo
E
D'Andrea
Emma
E
Al-Nahhas
Adil
A
Banti
Elena
E
Muzzio
Pier Carlo
PC
Rubello
Domenico
D
D000328:Adult; D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000000981:diagnostic imaging*; D016393:Lymphoma, B-Cell / Q000000981:diagnostic imaging*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging*; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18