An 84 yrs old male with a past medical history of HTN and renal insufficiency presented with one month history of swelling in the right hard palate. He had difficulty lying on his right side due to pain but was otherwise asymptomatic. Biopsy of the lesion revealed large B-cell lymphoma. PET-CT was performed for whole body staging.

PET-CT showed hypermetabolic soft tissue masses in the: right hard palate (SUV 6.3), liver (SUV 8.0), and bilateral kidneys. Multiple bone lesions were also seen involving: focus in the sternum, the left 7th rib posteriorly, and the left transverse element of T8 vertebrae. No hypermetabolic lymphadenopathy was seen on PET-CT (extranodal lymphoma). Due to the unusual presentation liver biopsy was performed (to rule out a synchronous primary), which also showed large B-cell lymphoma.

Patient was treated with R-CVP (rituximab, cyclophosphamide, vincrisine and prednisone) with adriamycin added in the second cycle. PET-CT obtained post 2 cycles of chemotherpy showed complete resolution of all hypermetabolic lesions, suggesting good response to therapy.

1. Fluorine-18 fluorodeoxyglucose PET/CT patterns of extranodal involvement in patients with Non-Hodgkin lymphoma and Hodgkin’s disease. Even-Sapir E, Lievshitz G, Perry C, Herishanu Y, Lerman H, Metser U. Radiol Clin North Am. 2007 Jul;45(4):697-709

2. PET and PET/CT in management of the lymphomas. Podoloff DA, Macapinlac HA. Radiol Clin North Am. 2007 Jul;45(4):689-96.

3. Normal and abnormal patterns of 18F-fluorodeoxyglucose PET/CT in lymphoma. Bar-Shalom R. Radiol Clin North Am. 2007 Jul;45(4):677-88

This case was compiled by Dr. Sania Rahim-Gilani and Dr. David He, BCM