Diffuse hepatic infiltration of lymphoma is extremely rare [1]. Conventional imaging techniques (CT, MR and ultrasound) usually fail to identify the abnormality. 18F-FDG PET is valuable in detecting diffuse hepatic diseases [2, 3].
A 58-year-old man was admitted to our hospital owing to fever of unknown origin for 2 weeks and jaundice for 10 days. Non-contrast CT images of chest, abdomen and pelvis showed a tender hepatomegaly, splenomegaly and ascites. A hepatic focal or diffuse lesion and enlargement of lymph nodes were not shown. Ultrasound identified hepatomegaly without any definite hepatic lesions. Magnetic resonance cholangiopancreatography results (MRCP) were negative. Hematology-oncology consultation suggested a possible diffuse malignant infiltration process such as lymphoma or leukemia. Subsequently, a bone marrow biopsy and whole-body 18F-FDG PET/CT scan were performed. There was no evidence of malignancy on bone marrow biopsy. PET/CT images (a–d, Note: The artifact on b & d is because the patient could not lift his arms during the examination) demonstrated diffuse increased 18F-FDG uptake in the entire liver (“hepatic superscan”). PET/CT images strongly indicated the diagnosis of hepatic lymphoma. Liver biopsy showed a non-germinal center subtype of diffuse large B-cell lymphoma. Immunohistochemical stains (e–g) were positive for CD20 and MUM-1, and negative for CD10 and BCL-6. The patient died 2 days after liver biopsy due to rapid progression of the disease; an autopsy was not performed.
This case highlights PET, rather than other imaging techniques, is of great value in detecting diffuse hepatic infiltration of lymphoma with characteristic appearance of “hepatic superscan”.
References
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Du B, Li X, Li N, Li Y, Hsu B. 18F-FDG hepatic superscan in a patient with chronic myeloid leukemia. Clin Nucl Med. 2014;39:835–6.
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Yang, G., Nie, P., Wang, Z. et al. 18F-FDG hepatic superscan caused by a non-germinal center subtype of diffuse large B-cell lymphoma. Eur J Nucl Med Mol Imaging 43, 1928 (2016). https://doi.org/10.1007/s00259-016-3399-0
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DOI: https://doi.org/10.1007/s00259-016-3399-0