Abstract
Subcutaneous panniculitis such as T-cell lymphoma (SPTCL) is a very rare disorder. Patients usually present with multiple subcutaneous nodules on the extremities without visceral disease. Dissemination to extra-cutaneous sites is unusual. Only a few cases of SPTCL have been reported in the literature describing the findings of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Here, we represent an interesting and unusual case of diffuse SPTCL with snow Leopard skin appearance on 18F-FDG PET/computed tomography.
Keywords: Panniculitis-like T-cell lymphoma, snow Leopard skin, 18F-FDG PET/CT
Abstract
Subkütan pannikülit benzeri T-hücreli lenfoma (SPTCL) çok nadir görülen bir hastalıktır. Hastalar genellikle ekstremitelerde visseral hastalık olmaksızın çok sayıda subkütan nodül ile başvurdular. Ekstra-kutanöz bölgelere yayılım alışılmadık bir durumdur. Literatürde, 18F-florodeoksiglukoz (FDG) pozitron emisyon tomografisi (PET) bulguları bildirilen yalnızca birkaç SPTCL olgusu bildirilmiştir. Burada, 18F-FDG PET/bilgisayarlı tomografide kar Leoparı deri görünümü olan, diffüz SPTCL’li ilginç ve alışılmadık bir olguyu sunuyoruz.
Figure 1.
A 22-year-old female patient, presented with macrophage activation syndrome in the context of diffuse subcutaneous panniculitis such as T-cell lymphoma (SPTCL), was referred to our positron emission tomography (PET) unit to evaluate initial staging. Whole-body non-contrast-enhanced 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) was performed, and the 3D maximal intensity projection showed a snow Leopard skin appearance with multiple disseminated hot spots throughout the subcutaneous tissues (panel A). Fusion images in axial sections revealed areas of abnormal increased uptakes corresponding to diffuse subcutaneous 18F-FDG multiple micronodular (panel B). Our PET/CT also showed nodal uptakes in right inguinal lymph-nodes with maximum standard uptake value: 8.6 (panel C). SPTCL is a very rare disorder in which all patients are usually presented with multiple subcutaneous nodules on the extremities and trunk without visceral disease (1). It represents 1% of cases of non-Hodgkin’s lymphoma (2). Dissemination to extra-cutaneous sites is unusual, and SPTCL may be preceded for years by a seemingly benign panniculitis (3). In our knowledge, just a few cases have been reported in the literature, describing the appearance of SPTCL on 18F-FDG PET (4). Without histology confirmation, snow Leopard skin appearance on 18F-FDG PET/CT can be related to other origins such as: benign panniculitis, sarcoidosis, and cutaneous polyarteritis nodosa (5,6).
Footnotes
Ethics
Informed Consent: All appropriate patient consent forms were obtained. In this form, the patient gave consent for their pictures and other clinical information to be reported in the journal.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Surgical and Medical Practices: S.N.O., Concept: S.N.O., L.E.A., O.A.S., Design: S.N.O., L.E.A., O.A.S., Data Collection or Processing: S.N.O., Y.B., Analysis or Interpretation: S.N.O., Literature Search: S.N.O., Writing: S.N.O., A.D.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.
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