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      False Negative 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Primary B-cell Lymphoma of the Bone

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          Abstract

          We present a case of a 15-year-old male with primary bone lymphoma who was initially referred for suspicion of chronic osteomyelitis of the mandible. A bone scan and gallium scan demonstrated congruent uptake in the mandible, suggestive of chronic osteomyelitis. A biopsy subsequently showed B-cell lymphoma of the bone with low Ki-67. A fluorodeoxyglucose positron emission tomography (FDG-PET) scan performed before therapy for staging revealed no increased uptake in the mandible. This case shows an atypical presentation of a rare disorder and is presented to emphasize the importance of baseline FDG-PET.

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          Primary lymphoma of bone in adult patients.

          Sean P. Scully, Kenneth M. C. Cheung, M Schneiderbauer … (2010)
          The low incidence of primary lymphoma of bone (PLB) has led to discrepancies in classification as well as difficulty in prognostication. The authors of this report used the Surveillance, Epidemiology, and End Results (SEER) database to analyze a large, population-based cohort of adult patients with this disease. The database provides a standardized classification and documentation of outcomes and enables a meaningful evaluation of prognostic factors. The SEER database was used to identify all patients who were diagnosed with PLB from 1973 through 2005. Survival was analyzed with the Kaplan-Meier method, and the influence of clinical parameters on survival was analyzed with the log-rank test. A Cox proportional hazards model was used for multivariate analysis. Fifteen hundred adult patients with PLB were analyzed. The 5-year and 10-year survival rates for adult patients were 58% and 45%, respectively. Multivariate analysis revealed that younger age and localized disease were independent predictors of survival. It is noteworthy that the incidence of disease, as determined by the annual percentage change, increased during the study period (P < .05). This analysis of a large cohort of adults with PLB indicated that the only identifiable prognostic indicators were localized disease and younger age. The authors concluded that future treatment for patients with PLB need to be based on strict staging criteria and adherence to successful published protocols using collaborative clinical trials.
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            Primary non-Hodgkin's lymphoma of bone: a clinicopathological investigation of 60 cases.

            Jamie Kramer, P M Kluin, Hanneke Kluin-Nelemans … (1999)
            A retrospective analysis of patients presenting with primary lymphoma of bone (PLB) was performed to determine clinical factors affecting prognosis in relation to histological subtype and treatment outcome. Data from 106 patients, presenting with a PLB between 1943 and 1996, were retrieved from the files of the Netherlands Committee on Bone Tumours and Leiden University Medical Centre. The lymphomas were reclassified according to the REAL and updated Kiel classification. The clinical presentation, survival and prognostic factors were investigated. Sixty patients had sufficient clinical information and adequate follow-up to be included in the study. All 33 PLB that could be immunophenotyped were of B cell origin. According to the REAL classification, most PLB were large (B) cell lymphomas (92%) and according to the Kiel classification 45% of the tumours were centroblastic multilobated. PLB presented most often in the long bones (48%), with Ann Arbor stage I (46%), II (16%), IV (16%) and unknown (20%). Stage IV disease was exclusively caused by the presence of multiple bone lesions. Notwithstanding the heterogeneous treatment, the 5-year overall survival was 61%; 46% of patients were progression free at 5 years. Patients at presentation older than 60 had a worse overall survival (76% vs 37%, P = 0.0002) and a worse progression-free period (58% vs 28%, P = 0.0073). Patients with the immunoblastic subtype had a worse survival than the centroblastic mono/polymorphic subtype or the centroblastic multilobated subtype (P = 0.015). Primary lymphoma of bone represents an uncommon bone tumour with a relatively homogeneous morphology and clinical behaviour. Compared to other aggressive lymphomas, PLB have a favourable prognosis.
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              Primary bone lymphoma: A case report and review of the literature

              Hai-Yan Zhou, Fang Gao, BING BU … (2014)
              Primary lymphoma of the bone (PLB) primarily arising from the medullary cavity is an extremely rare entity, with only retrospective studies and sporadic cases reported in the literature. The current study presents one case of PLB treated with chemotherapy and radiotherapy, and a review of the literature to elucidate the optimal treatment of PLB. A 73-year-old female presented with pain in the left hip that had persisted for two months. Plain X-ray and magnetic resonance imaging of the left hip showed lytic areas involving the left innominatum. Technetium-99m radionuclide imaging showed increased tracer uptake in the ilium, acetabulum and ischium. An 18F-fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) scan showed high FDG uptake. A fine-needle aspiration biopsy of the lesion was performed, and histopathological and immunohistochemical examination confirmed a diagnosis of B-cell lymphoma. The patient received radiation therapy followed by six cycles of CHOP regimen (1,000 mg cyclophosphamide, 80 mg epirubicine and 2 mg vincristine on day one, and 100 mg prednisone on days one to five, every three weeks) and achieved a complete response, as confirmed by FDG-PET-CT. At present, the patient is in a good condition. This case is noteworthy, as it is a well-documented case in which the patient received successful treatment. This case demonstrates that PLB has an improved prognosis compared with primary lymphoma of other sites; however, combined therapy may further improve the patient outcome.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Nucl Med
                Journal ID (iso-abbrev): World J Nucl Med
                Journal ID (publisher-id): WJNM
                Title: World Journal of Nuclear Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1450-1147
                ISSN (Electronic): 1607-3312
                Publication date (Print): Apr-Jun 2017
                Volume: 16
                Issue: 2
                Pages: 166-168
                Affiliations
                [1]Division of Nuclear Medicine, University of Ottawa, Ottawa, Ontario, Canada
                [1 ]Department of Nuclear Medicine, Hopital Ste-Justine, Quebec, Canada
                Author notes
                Address for correspondence: Dr. Matthieu Pelletier-Galarneau, Division of Nuclear Medicine, The Ottawa Hospital, General Campus, 501 Smyth Road, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada. E-mail: mattgalarneau@ 123456gmail.com
                Article
                Publisher ID: WJNM-16-166
                DOI: 10.4103/1450-1147.203070
                PMC ID: 5436326
                SO-VID: 6a14db86-a91c-4808-ac2e-78d1294b4d55
                Copyright © Copyright: © 2017 World Journal of Nuclear Medicine
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: fluorodeoxyglucose positron emission tomography/computed tomography,ki-67,primary bone lymphoma
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: fluorodeoxyglucose positron emission tomography/computed tomography, ki-67, primary bone lymphoma

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