title: Distal appendicular skeletal involvement of diffuse large B-cell lymphoma on technetium-99m methylenediphosphonate bone scintigraphy and18F-fluorodeoxyglucose positron emission tomography/computed tomography: a case report.
abstract: BACKGROUND
  We 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) and18F-fluorodeoxyglucose positron emission tomography/computed tomography.
  
  
  METHODS
  A 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu, 705-718, Korea.
authors.forename: Insook
authors.initials: I
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu, 705-718, Korea. kufa77@hanmail.net.
authors.forename: Sungmin
authors.identifier: http://orcid.org/0000-0003-1959-8578
authors.initials: S
authors.lastname: Kang
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D004164:Diphosphonates; D019788:Fluorodeoxyglucose F18; D005891:Gingivitis / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D015609:Organotechnetium Compounds; D000072078:Positron Emission Tomography Computed Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D011878:Radiotherapy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D014081:Tooth Extraction; D016896:Treatment Outcome; D051598:Whole Body Imaging
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C114890:technetium 99m methylene bisphosphonate; D019788:Fluorodeoxyglucose F18
keywords: 18F-fluorodeoxyglucose positron emission tomography/computed tomography; Appendicular bone involvement; Diffuse large B-cell lymphoma; Technetium-99m methylenediphosphonate bone scintigraphy