Burkitt Lymphoma Involving Multiple Rare Extralymphatic Sites Uncovered in an FDG PET/CT

A 30-year-old male presented with complaints of a left cervical mass for the last 2 months, which, upon histopathological examination, revealed features suggestive of Burkitt lymphoma.

On retrospective review, he did not report any B symptoms. A staging ¹⁸F fludeoxyglucose positron emission tomography/ computed tomography (¹⁸F FDG PET/CT) was performed [Figure 1].

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Figure 1:

A staging 18F fludeoxyglucose positron emission tomography/computed tomography (18F FDG PET/CT) was performed. The Maximum Intensity Projection image (a) shows intensely FDG avid extensive disease on both sides of the diaphragm. (b)Fused images revealed FDG avid: Enlarged, hyperenhancing left level II cervical lymph node; (c ) multiple wall thickening involving the jejunum and ileum; (d) multiple hypodense lesions in both lobes of the liver; enlarged left gastric lymph node; intraluminal hyperenhancing wall thickening of the greater curvature of the stomach; hyperenhancing intraluminal growth involving the fundus of gallbladder ;and hypodense lesions involving the renal cortices; (e) marrow based lesions in the right 7th rib and right ilium ;( f) multiple wall thickening involving the jejunum and ileum; (g) hyperenhancing polypoidal growth in the sigmoid colon ;(h)Post chemotherapy, a response assessment 18F FDG PET/CT revealed no metabolically active/structural lesions, suggesting a complete response to therapy.

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The Maximum Intensity Projection image (a) shows intensely FDG avid extensive disease on both sides of the diaphragm. Fused images revealed FDG avid: Enlarged, hyperenhancing left level II cervical lymph node (b); multiple hypodense lesions in both lobes of the liver; enlarged left gastric lymph node; intraluminal hyperenhancing wall thickening of the greater curvature of the stomach; hyperenhancing intraluminal growth involving the fundus of gallbladder (d); hypodense lesions involving the renal cortices (d); multiple wall thickening involving the jejunum and ileum (c and f); hyperenhancing polypoidal growth in the sigmoid colon (g); marrow based lesions in the right 7th rib and right ilium (e). Post chemotherapy, a response assessment 18F FDG PET/CT (h) revealed no metabolically active/structural lesions, suggesting a complete response to therapy^[1-4] and confirming the lymphomatous origin of all observed lesions. Uncommon sites of involvement of Burkitt lymphoma include the ileum, stomach, cecum, mesentery, kidney, testis, ovary, breast, bone marrow, and central nervous system.^[5-9] FDG PET/CT demonstrated multiple, rare extranodal sites of Burkitt Lymphoma, such as the gallbladder and kidneys. Particularly, involvement of the gallbladder is extremely rare, with only 5 previous reports^[10-14] of the same available in the literature.