Central photopenic lesions on FDG-PET scan in a patient with peripheral T cell lymphoma

Our plain-English summary of Central photopenic lesions on FDG-PET scan in a patient with peripheral T cell lymphoma, by A. Mavi, T. Dhuriraj, T.F. Cermik, et al (Annals of Nuclear Medicine, 2008).

The study

• Authors: A. Mavi, T. Dhuriraj, T.F. Cermik, M. Urhan, M. Wasik, S. Basu, R. Kumar, D. Torigian, A. Alavi
• Journal: Annals of Nuclear Medicine
• Published: 2008;22(7):629-33
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Central necrosis in lymphoma lesions as demonstrated in [(18)F] fluoro-2-deoxyglucose positron emission tomography (FDG-PET) studies is a rare phenomenon, and the clinical significance of this observation has not been described in the literature. The role of FDG-PET in the management of peripheral T cell lymphoma (PTCL) is also still unclear at this time. We present a case of a patient newly diagnosed with PTCL who underwent both computed tomography (CT) and FDG-PET examinations prior to and following therapy. CT showed pulmonary cavitary lesions in both lungs, and PET demonstrated multiple large confluent masses with intense FDG uptake in the corresponding lung fields with central photopenia suggestive of necrosis. Post-treatment FDG-PET images showed a significant improvement in the previously described lesions with some residual, recurrent, and new lesions. Central necrosis shown by PET may be associated with the advanced stage of the disease and may have prognostic implications because of central necrosis caused by hypoxia.

In plain English

This article was a case report about one patient: a 51-year-old male nonsmoker, described as alcoholic, who had three months of progressive shortness of breath and cough. The patient had a history of asbestos exposure from former work as a welder. The article mentioned this only as background, did not name a fiber type, and did not examine any link between asbestos and the illness. A lung biopsy showed peripheral T cell lymphoma, a cancer of immune cells, with extensive tissue death (necrosis). Before treatment, a CT scan showed cavitary lesions in both lungs. An FDG-PET scan showed large masses with intense uptake and dark centers suggesting necrosis. After chemotherapy and a stem cell transfusion, a PET scan 6 months after diagnosis showed significant improvement, with a few small residual spots and a new spot in the left lower chest wall. CT showed new lung nodules suspicious for recurrent lymphoma. The authors concluded that necrosis seen on PET may be associated with advanced disease and may have prognostic implications.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One patient: a 51-year-old male nonsmoker, described as alcoholic, with a 3-month history of progressive shortness of breath, dyspnea and cough, newly diagnosed with peripheral T cell lymphoma
• Exposure: History of asbestos exposure during former work as a welder, mentioned as patient history only. No fiber type or dose is given, and the article does not study asbestos as a cause. The imaging studied was FDG-PET and CT before and after chemotherapy.
• Main results:
  • Pre-treatment CT of the chest and abdomen in this patient showed multiple cavitary lesions in both lungs, with no enlarged hilar, mediastinal or axillary lymph nodes; multiple liver lesions and an enlarged spleen were also seen
  • Lung biopsy findings were most compatible with a peripheral T cell lymphoma of CD4+ T cell origin, angiocentric, with extensive necrosis
  • Pre-therapy FDG-PET showed multiple large confluent masses with intense FDG uptake and central photopenia (dark centers) in both lungs, suggestive of active disease with areas of necrosis
  • After two cycles of CHOP chemotherapy showed no significant change, the patient received six cycles of ICE chemotherapy and then a peripheral stem cell transfusion; lactate dehydrogenase was 1109 U/l before treatment (normal 313 to 618 U/l) and 826 U/l at follow-up
  • PET 6 months after diagnosis showed significant improvement, with a few residual small foci of increased FDG uptake in the right middle lobe and left upper lobe (according to the main text), interpreted as partial response to therapy
  • A new focus of increased FDG activity appeared in the left lower chest wall, approximately in the region of the posterior ninth or tenth rib
  • Comparing pre-therapy and post-therapy chest CT showed a decrease in upper lobe masses, with new nodules and masses in the right middle lobe and left lower lobe suspicious for recurrent lymphoma
  • The authors stated that in this case necrosis was not obvious from CT alone, and that FDG-PET added value for showing the presence and total amount of necrosis in the masses
• The authors' conclusion: The authors concluded that central necrosis shown by PET may be associated with advanced stage of disease and may have prognostic implications, possibly predicting poor response to therapy because of hypoxia (low oxygen) in the lesions

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: PET Scan, Necrosis, Hypoxia.

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