Chest Wall Mass as the Dominant Presentation of Low-Grade B-Cell Non-Hodgkin's Lymphoma: A Case Report

Abstract

Low-grade B cell non-Hodgkin's lymphoma with dominant presentation of chest wall mass is presented in this report. The patient, a 65-year-old woman, presented with pain, rising skin temperature and redness, and swelling on the right lower chest wall. The histopathological examination revealed non-Hodgkin's lymphoma; the staging fluorodeoxyglucose-positron emission tomography/computed tomography demonstrated stage IVE disease, with hypermetabolic active disease in the right anterolateral chest wall in the form of large soft tissue mass and subcutaneous tissue with underlying bony erosion with extension into right anterior cardiophrenic space and superiorly up to right second costosternal region along the right internal mammary vessels. This was along with hypermetabolic active right axillary, right supraclavicular and left inguinal lymphadenopathy, and thickened hypermetabolic posterior right pleura with ametabolic right-sided pleural effusion. Bone marrow biopsy revealed uninvolved bone marrow. On follow-up after eight cycles of R-CHOP chemotherapy, the mass had completely resolved on contrast-enhanced computed tomography.

Keywords: B cell non-Hodgkin's lymphoma; FDG; PET/CT; primary extranodal lymphoma; staging.

Fig. 1

( A ) Maximum intensity projection positron emission tomography (PET) image, ( B , C ) fused positron emission tomography/computed tomography (PET/CT) and noncontrast CT axial images, ( D , E ) fused PET/CT and noncontrast CT coronal images, ( F , G ) fused PET/CT and noncontrast CT sagittal images showing metabolically active lesions in large soft tissue mass seen involving the right anterolateral chest wall and subcutaneous tissue extending overlying skin surface and underlying bony erosion with extension into the right anterior cardiophrenic space and superiorly along the right internal mammary vessels up to the level of right second costosternal region. Few hypermetabolic right axillary and right supraclavicular nodes and infradiaphragmatic left inguinal nodes were also noted along with hypermetabolic active disease in thickened posterior right pleural with ametabolic right pleural effusion.

Fig. 2

( A–C ) positron emission tomography (PET), computed tomography (CT) (lung window), and fused PET/CT axial images and ( D–F ) PET, CT (lung window), and fused PET/CT coronal images showing metabolically active lesions in large soft tissue mass seen involving the right anterolateral chest wall and subcutaneous tissue extending to overlying skin surface and underlying bony erosion; ( G–I ) PET, CT (lung window), and fused PET/CT sagittal images showing metabolically active lesions in thickened posterior right pleura with ametabolic right pleural effusion.