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Review
. 2020 Jan;99(1):e18640.
doi: 10.1097/MD.0000000000018640.

Recurrence of nasal type NK/T cell lymphoma presenting as neurolymphomatosis on 18F-FDG PET/CT: A case report and literature review

Qingqing Pan  1   2 , Yaping Luo  1   2
Affiliations
Review

Recurrence of nasal type NK/T cell lymphoma presenting as neurolymphomatosis on 18F-FDG PET/CT: A case report and literature review

Qingqing Pan et al. Medicine (Baltimore). 2020 Jan.

Abstract

Introduction: NK/T cell lymphomas seldom involve the peripheral nervous system. We report a case of recurrent nasal type NK/T cell lymphoma presenting as neurolymphomatosis and its manifestation on F-FDG PET/CT.

Patient concerns: A 55-year old man presented with a mass in the right nasal cavity was diagnosed with extranodal NK/T cell lymphoma, nasal type. F-FDG PET/CT showed intense FDG uptake within the mass. After radiotherapy the nasal tumor was completely relieved, but the patient experienced numbness and amyosthenia in the right upper extremity one week after completion of radiotherapy.

Diagnosis: PET/CT showed intense FDG uptake in the brachial plexus, axillary, suprascapular and median nerves, suggestive of recurrence of lymphoma presenting as neurolymphomatosis.

Interventions: After 1 cycle of chemotherapy, the follow-up PET/CT showed markedly reduced FDG uptake in the previous involved nerves, demonstrating a very good response of neurolymphomatosis to chemotherapy.

Outcomes: The patient finally had a progression free survival of 8 months after completion of 4 cycles of chemotherapy and autologous stem cell transplantation.

Lessons: As neurolymphomatosis is a rare neurologic manifestation in recurrence of NK/T cell lymphoma, recognition of its presentation is important for prompt diagnosis and initiating treatment approach.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
FDG PET/CT at baseline assessment. PET MIP (A), axial fusion image (B) and axial CT (C) showed a mass with intense FDG uptake in the right nasal cavity with size of 4.1×2.3 and SUVmax of 26.0.
Figure 2
Figure 2
Follow-up PET/CT after radiotherapy. PET MIP (A), axial fusion image (B) and axial CT (C) revealed intense FDG uptake in the brachial plexus, axillary, suprascapular and median nerve with SUVmax of 19.9, suggesting recurrence of lymphoma.
Figure 3
Figure 3
MR images showed the right brachial plexus and axillary nerves had hypersignal intensity in T2WI (A-B); the involved nerves were also hyperintense in DWI (C-D).
See this image and copyright information in PMC

References

    1. Briani C, Visentin A, Campagnolo M, et al. Peripheral nervous system involvement in lymphomas. J Peripher Nerv Syst 2019;24:5–18. - PubMed
    1. Grisariu S, Avni B, Batchelor TT, et al. Neurolymphomatosis: an international primary CNS Lymphoma Collaborative Group report. Blood 2010;115:5005–11. - PMC - PubMed
    1. Zhou WL, Wu HB, Weng CS, et al. Usefulness of 18F-FDG PET/CT in the detection of neurolymphomatosis. Nucl Med Commun 2014;35:1107–11. - PubMed
    1. Salm LP, Van der Hiel B, Stokkel MP. Increasing importance of 18F-FDG PET in the diagnosis of neurolymphomatosis. Nucl Med Commun 2012;33:907–16. - PubMed
    1. Baehring JM, Damek D, Martin EC, et al. Neurolymphomatosis. Neuro Oncol 2003;5:104–15. - PMC - PubMed

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