Tiger-man Appearance in a Case of DLBCL

Abstract

Primary cutaneous Epstein-Barr virus-positive diffuse large B-cell lymphoma (PC-EBV-DLBCL) is a rare and aggressive neoplasm with a poorer prognosis than other cutaneous lymphoma. Here, we present the ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) scan findings of a 39-year-old male with erythematous ulcerative nodules, which showed a gamut of cutaneous lesions consistent with EBV-associated PC-DLBCL. We highlight the utility of ¹⁸F-FDG PET/CT in evaluating the extent of disease, involvement of extranodal sites, and response to treatment in PC-EBV-DLBCL.

Keywords: 18F-fluorodeoxyglucose; diffuse large B‐cell lymphoma; inflammation; lymphoma; positron emission tomography/computed tomography; primary cutaneous lymphoma.

Figure 1

MIP Image of the whole body (a) shows increased metabolism involving the entire cutaneous area showing Tigerman appearance. Fused PET/CT images (b, sagittal and c-g, axial) shows hypermetabolism in the multiple areas of patchy plaque like soft tissue thickening with intense FDG uptake involving the muscular, cutaneous and sub-cutaneous plane in the neck, thorax, abdomen, bilateral upper and lower limbs along with soft tissue thickening in the right psoas muscle (blue arrow in f) and bilateral cervical lymphadenopathy. Ulcerations seen on the back (h).