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Tiger-man Appearance in a Case of DLBCL
Address for correspondence: Dr. Nishikant Avinash Damle, Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail: nishikantavinash@gmail.com
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Received: ,
Accepted: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Primary cutaneous Epstein–Barr virus‐positive diffuse large B‐cell lymphoma (PC‐EBV‐DLBCL) is a rare and aggressive neoplasm with a poorer prognosis than other cutaneous lymphoma. Here, we present the 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) scan findings of a 39-year-old male with erythematous ulcerative nodules, which showed a gamut of cutaneous lesions consistent with EBV-associated PC‐DLBCL. We highlight the utility of 18F-FDG PET/CT in evaluating the extent of disease, involvement of extranodal sites, and response to treatment in PC‐EBV‐DLBCL.
Keywords
18F-fluorodeoxyglucose
positron emission tomography/computed tomography
diffuse large B‐cell lymphoma
inflammation
lymphoma
primary cutaneous lymphoma
A 39-year-old male presented with erythematous ulcerative nodules which were gradually enlarging reddish and painless cutaneous-subcutaneous masses surrounded with some erythematous patches and ulcers on his back for 1 year. Clinical examination revealed impaired general condition and multiple large ulcerations, the largest measuring 15 cm × 10 cm on the back with no evidence of mucosal lesions or peripheral lymphadenopathies. Further, his blood investigations showed elevated lactate dehydrogenase levels (405 U/L). Histopathological examination of the tissue from the skin lesion revealed atypical lymphoid cells. 18F-FDG PET/CT was done to rule out systemic involvement [Figure 1].
Discussion
DLBCL is the most frequent lymphoma subtype and aggressive tumor of mature B-cells, accounting for 25% of all lymphoma subtypes.[1] EBV is a ubiquitous lymphotropic herpesvirus that infects 80%–90% of adults and is also highly associated with lymphoproliferative disorders.[2] PC‐EBV‐DLBCL is a type of DLBCL that is rare, affects the elderly due to process called inflammaging[3] and has an aggressive course with a poorer prognosis than other cutaneous lymphoma. The clinical presentations of PC EBV-positive DLBCL are variable, ranging from a single nodule to multiple ulcerative plaques.[4] PC-EBV-DLBCL is diagnosed with a skin biopsy with or without an excisional biopsy of a suspicious lymph node, which always shows positivity for EB encoded small RNA as shown in our case. 18F-FDG PET/CT has shown positive uptake in DLBCL and plays a crucial role in the assessment of disease burden along with response to treatment.[5] 18F-FDG PET/CT have shown positive correlation with EBV associated mucocutaneous ulcers.[6] Similar type of hypermetabolism in FDG is seen in cases of sarcoid myopathy[78] and dermatomyositis[9] where in, there will be muscular and cutaneous involvement. As demonstrated in our case, an exceptional cause of multiple cutaneous ulcers in an adult patient corresponding to a PC-EBV-DLBCL and 18FDG PET/CT is useful in identifying the disease and extracutaneous involvement and also for response assessment.[10]
Conflicts of interest
There are no conflicts of interest.
Nil.
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