Sir,
18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has now become the imaging modality of choice for high-grade lymphomas. Being a highly sensitive whole-body metabolic imaging technique, it can demonstrate unusual sites of involvement in these patients, which could be otherwise missed. We present such a case here. A 65-year-old male presented with cervical lymphadenopathy along with progressive weakness, weight loss, and fatigue. Biopsy from the cervical node confirmed diffuse large B-cell lymphoma (DLBCL). A staging contrast-enhanced 18F-FDG PET-CT was performed. 18F-FDG PET-CT [Figure 1a–e] showed lymph nodal involvement on both sides of diaphragm along with splenic involvement. Also noted was hypermetabolic right breast nodule suggesting involvement [Figure 1a–e, bold arrow]. Maximum standardized uptake value of this lesion was 6.2. Based on 18F-FDG PET-CT findings, a diagnosis of stage IVBE DLBCL was made. A clinical examination was done thereafter which revealed bilateral age-related gynecomastia, firmer and slightly tender on right side, further supporting the diagnosis. The patient was started on rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone chemotherapy but was lost to follow-up after two cycles.
Figure 1.
Maximum intensity projection PET image (a) showing hypermetabolic lymphadenopathy both above and below the diaphragm (broken arrows), along with hypermetabolic splenomegaly (arrowhead). Also noted was focal18-FDG uptake in right anterior chest wall (bold arrow). Transaxial and sagittal CT and PET-CT (b-e) images of the thorax showing focal hypermetabolism involving right breast nodule measuring 17 mm × 15 mm, suggesting involvement (bold arrow). 18F-FDG PET-CT: 18F-fluorodeoxyglucose positron emission tomography-computed tomography
Breast involvement in lymphoma could be either primary or secondary with latter being more common.[1] Lymphoma accounts for < 0.5% of all breast malignancies. Hence, lymphoma of male breast is even rarer.[2] In these patients, it can present with gynecomastia.[3] DLBCL is the most common histopathological subtype.[4] Management is with chemotherapy and adjuvant radiotherapy when required while surgery has no definite role.[5] As for lymphoma of other sites, 18F-FDG PET-CT plays an important role in the management of primary and secondary breast lymphoma.[6,7] In the present case, while the patient had bilateral gynecomastia clinically, lymphomatous involvement was only seen in right breast. This case reiterates the importance of 18F-FDG PET-CT in the management of patients with high-grade lymphoma by demonstrating usual sites of involvement.
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Conflicts of interest
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