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13 March 2024 : Case report  Taiwan

[In Press] Recurrent Marginal Zone Lymphoma with Bone Marrow Involvement Detected by ¹⁸F-FDG PET/CT and Biopsy: A Diagnostic Challenge

Mistake in diagnosis

Yeong-Shin Hsiao1EF, Shu-Chane Shen2BCD, Shih-Chuan Hsiao3BCDEF

DOI: 10.12659/AJCR.943275

Am J Case Rep In Press; DOI: 10.12659/AJCR.943275  

Available online: 2024-03-13, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Marginal zone lymphoma is a low-grade, B-cell, non-Hodgkin lymphoma. Bone marrow involvement (BMI) of leukemia or lymphoma can usually be displayed in fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) with high standardized uptake values (SUV), while diffuse homogeneous ¹⁸F-FDG bone marrow uptake (BMU) in PET/CT primarily reflects hyperplastic bone marrow status. This report is of a 74-year-old man presenting with anemia and a diagnosis of recurrent marginal zone lymphoma with bone marrow involvement identified with 18F-FDG PET/CT imaging and biopsy.
CASE REPORT
A 64-year-old man with severe anemia and body weight loss of 7 kg in 1 month was diagnosed with marginal zone lymphoma, stage III, in July 2011. He went into complete remission in April 2012 after 6 cycles of chemotherapy, with Hb restored. Anemia and diffuse homogeneous ¹⁸F-FDG BMU in PET/CT were then noted during a routine check-up in October 2021, and recurrent disease was established through positive biopsy of subcutaneous nodules and bone marrow. Subsequent complete remission after 6 cycles of combination therapy was validated with pathologically negative BMI, the resolution of the slightly enhanced ¹⁸F-FDG BMU in PET/CT, and restored hemoglobin.
CONCLUSIONS
This report has highlighted the importance of follow-up for patients with lymphoma and supports the diagnostic role of ¹⁸F-FDG PET/CT imaging and the pathological verification in identifying malignant involvement in bone marrow.

Keywords: Lymphoma, B-Cell, Marginal Zone; Positron Emission Tomography Computed Tomography; Bone Marrow; Case Reports

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923