Granulomatous dermatitis: a rare pitfall in lymphoma staging with [18F]FDG-PET/CT
verfasst von:
Johanna S. Enke, Alexander Gäble, Nic G. Reitsam, Tina Schaller, Martin Trepel, Klaus Hirschbühl, Julia Welzel, Alexander Dierks, Malte Kircher, Constantin Lapa
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
A 36-year-old male with anaplastic large T cell lymphoma (A; nodal manifestations in the left iliac and left inguinal region, arrow) who had received six cycles of chemotherapy (brentuximab vedotin, cyclophosphamide, doxorubicin, and prednisone) presented for restaging prior to autologous stem cell transplantation. A few days earlier, the patient had noticed multiple new tender subcutaneous nodules, and erythemato-squamous, polymorphous, partially atrophic plaques all over his body (B1). [18F]FDG-positron emission tomography/computed tomography (PET/CT) showed complete metabolic response of primary lymphoma manifestations but revealed intense tracer accumulation in the disseminated subcutaneous nodules (B, axial image B2). Besides cutaneous involvement by T cell lymphoma, differential diagnoses included cutaneous sarcoidosis and pityriasis rosea. Biopsy of a subcutaneous nodule revealed no evidence of malignancy but granulomatous inflammation (B3) most consistent with reactive granulomatous dermatitis. After initiation of prednisone therapy, all (sub-)cutaneous lesions quickly resolved, and the patient was eligible for stem cell transplantation. Follow-up [18F]FDG-PET/CT demonstrated only residual tracer uptake of some lesions and a sustained complete lymphoma response (C).
Reactive granulomatous dermatitis is a very rare skin disease with only several hundred cases reported worldwide so far [1], most commonly associated with autoimmune disorders such as rheumatoid arthritis. Furthermore, it has been associated with hematologic malignancies, including — in approximately 3% of cases — (B cell) lymphoma [1‐3]. To our knowledge, this is one of the very first cases of granulomatous dermatitis in anaplastic large T cell lymphoma [4], and the first visualization of granulomatous dermatitis by [18F]FDG-PET/CT mimicking cutaneous lymphoma manifestations.
×
Anzeige
Declarations
Informed consent
Written informed consent for publication of this report and accompanying images was obtained from the patient.
Conflict of interest
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Mit e.Med Radiologie erhalten Sie Zugang zu CME-Fortbildungen des Fachgebietes Radiologie, den Premium-Inhalten der radiologischen Fachzeitschriften, inklusive einer gedruckten Radiologie-Zeitschrift Ihrer Wahl.
Granulomatous dermatitis: a rare pitfall in lymphoma staging with [18F]FDG-PET/CT
verfasst von
Johanna S. Enke Alexander Gäble Nic G. Reitsam Tina Schaller Martin Trepel Klaus Hirschbühl Julia Welzel Alexander Dierks Malte Kircher Constantin Lapa