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Review
. 2015 May;94(18):e833.
doi: 10.1097/MD.0000000000000833.

Non-Hodgkin's Lymphoma of Multiple Skeletal Muscles Involvement Seen on FDG PET/CT Scans

Yue Dai  1 , Medapati Sowjanya, Jia You, Kai Xu
Affiliations
Review

Non-Hodgkin's Lymphoma of Multiple Skeletal Muscles Involvement Seen on FDG PET/CT Scans

Yue Dai et al. Medicine (Baltimore). 2015 May.

Abstract

As normal healthy skeletal muscle does not contain lymphoid tissue, extra nodal lymphoma involving multiple muscles is rare, as well. This study reports a case of non-Hodgkin's lymphoma (NHL) of multiple skeletal muscles involvement and a review of differential diagnosis of it.A 37-year-old female presented to our hospital after being diagnosed with NHL for 7 months. She had received six courses of cyclophosphamide hydroxydaunorubicin oncovin prednisolone etoposide (CHOPE) chemotherapy. Then she felt pain and noticed swelling on her left calf. The fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) image showed abnormal focal FDG uptake in hypo-pharynx, which was the primary NHL and also in multiple groups of muscles in whole body. As the patient has history NHL, lymphoma of multiple muscle involvement was suspected.Finally, an ultrasound-guided tissue biopsy was performed on the left calf and histological examination yielded lymphomatous cells infiltration in the left gastrocnemius.Through this report, we emphasize that a multidisciplinary team approach with clinician, radiologist, and pathologist is essential for proper diagnosis, staging, and management of such rare lesions.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
A 37-year-old female with a history of non-Hodgkin's lymphoma felt pain and noticed swelling on her left calf was referred for an FDG PET/CT examination. The three-dimensional MIP image in coronal (A) and sagittal (B) plane demonstrated widespread FDG uptake lesions, including the primary lymphoma and multiple muscles, which are clearly visible (arrows). Selected trans axial slices of attenuation-corrected CT, PET, and fused PET/CT images showed abnormal focal FDG uptake at the level of hypo-pharynx (C), multiple groups of muscles (D–F), one of the site from where biopsy is taken (D).
FIGURE 2
FIGURE 2
Ultrasound-guided tissue biopsy was performed on the left gastrocnemius to obtain a definitive histological diagnosis. Hematoxylin and eosin stain (×400) of the lesion revealed neoplastic lymphocytes surrounding and invading myofibrils, which was consistent with non-Hodgkin's lymphoma of skeletal muscles.
See this image and copyright information in PMC

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