Lymphoma - 82-year-old male

History at Initial Staging
82-year-old male with history of hypertension and atrial fibrillation who presented with swelling in the right axilla and right cervical area for the last few months. The biopsy revealed anaplastic large cell lymphoma, CD-30 positive.

CT Findings
CT of neck and chest demonstrated shotty lymph nodes in the deep cervical chain, less than 1 cm. Borderline size lymph node adjacent to the right sternocleidomastoid muscle. In the chest, there were right axillary and possible left axillary adenopathy.

Initial PET Findings
The patient has extensive lymph node uptake extending from right mid neck to the right axilla. Lymph node uptake can be seen in the posterior cervical triangle as well as anterior jugular chain. There is also supraclavicular involvement. There are approximately 15-20 lymph nodes that are involved. These findings are consistent with lymphomatous involvement.

In the abdomen, there is a single 1 cm focus of hypermetabolic activity in the left upper quadrant. It appears to be within the spleen, in the anterior mid section. No discrete soft tissue mass can be seen on the CT exam that corresponds to this abnormality. However, because the signal intensity is as intense as the lymph node uptake in the neck, this too is suspicious for additional lymphomatous involvement. The remaining abdomen is normal. No abnormal pelvic uptake is present.

Dosage
15.4 mCi FDG

History at Re-staging (6 months)
82-year-old male with diagnosis of Hodgkin’s lymphoma in the left axillia 10 months ago. Patient referred for re-staging, 3 months post chemotherapy.

Re-staging PET Findings
There has been excellent response to treatment. No abnormal uptake is present in the right neck and axilla. The splenic lesion is also resolved. There are no new hypermetabolic activities suggestive of recurrent lymphoma.

Dosage
15.4 mCi FDG

Imaging
CTI REVEAL XL

Courtesy of
Thompson Cancer Survival Center