case_images: PMC5778714_01
case_images: (a) Maximal intensity projection of the staging 18F-fluorodeoxyglucose positron emission tomography/computed tomography showing areas of intense abnormal tracer uptake in the right suprarenal location and along the midline; (b and c) Transaxial fused positron emission tomography/computed tomography images localized the intense tracer uptake to a large suprarenal mass and to a few enlarged retroperitoneal lymph nodes; (d-f) maximal intensity projection and fused positron emission tomography/computed tomography images of interim positron emission tomography/computed tomography (following four cycles of chemotherapy) showing significant resolution in size and fluorodeoxyglucose avidity of the right suprarenal mass and retroperitoneal lymph nodes. (g-i) End of treatment positron emission tomography/computed tomography images (after two more cycles of chemotherapy) revealing disease relapse in the form of a right renal lesion and a few retroperitoneal lymph nodes
case_images: WJNM-17-46-g001.jpg
case_images: PMC5778714_01_WJNM-17-46-g001.jpg
case_images: F1
case_images: A whole-body 18F-FDG PET/CT was performed for further characterization, which revealed intense FDG uptake (maximum standardized uptake value [SUVmax] 20.0; ~9.8 cm x 7.0 cm x 7.8 cm) in the soft-tissue mass involving the right adrenal gland [Figure 1a and b]. A few intensely FDG avid (SUVmax 16.7) enlarged retroperitoneal (largest measuring ~3.6 cm x 2.4 cm), and cervical lymph nodes are also noted [Figure 1c]. The patient then received four cycles of R-CHOP regimen, and interim 18F-FDG PET/CT revealed faint FDG avidity (SUVmax 2 vs. 20 previously) of the right adrenal mass lesion and resolution of FDG avidity of the retroperitoneal and cervical lymphadenopathy suggesting a favorable response to therapy [Figure 1d-f]. FDG avidity in the right adrenal mass and appearance of renal lesions (SUVmax 18.3) and paracaval lymph nodes suggesting disease progression [Figure 1g-i]. Rapid cytopenia developed in the patient following chemotherapy, and the patient was changed to alternate chemotherapy regimen (R-ICE). Further deterioration in thrombocytopenia was noted in the patient after the first cycle, which lead to discontinuation of therapy and was followed by symptomatic treatment.
case_images: Photomicrographs showing (a) sheets of atypical lymphoid cells with large nuclei and moderate cytoplasm (H and E, x400); (b) membrane positivity of tumor cells for CD20; (c) atypical lymphoid cells showing positivity for CD79a; (d) CD3 immunostaining highlighting reactive cells (b-d: Immunoperoxidase, x400) confirming a diagnosis of diffuse large B-cell lymphoma
case_images: WJNM-17-46-g002.jpg
case_images: PMC5778714_01_WJNM-17-46-g002.jpg
case_images: F2
case_images: B-cell lymphoma (DLBCL) through immunotyping [Figure 2a-d]. Bone marrow aspiration was negative for lymphomatous infiltration, and the patient was staged as Ann Arbor Stage IIIE.