The Importance of F-18 FDG PET/CT in Guiding Biopsy and Initial Staging of Nasal Type Extra-Nodal Natural Killer/T-Cell Lymphoma: A Case Report

氟化去氧葡萄糖正子造影偵測鼻型淋巴結外自然殺手／T-細胞淋巴癌並引導切片檢查及協助其分期

周詩瑾(Shih-Chin Chou) ； 吳宜臻(Yi-Chen Wu) ； 黃俊穎(Jyum-Ying Huang) ； 陳輝墉(Huei-Yong Chen)

《核子醫學暨分子影像雜誌》 30卷2期 (2017/06) Pp. 82-89

https://doi.org/10.6332/ANMMI.3002.005

摘要

Correct diagnosis and staging leads the proper treatment in nasal type extra-nodal natural killer/ T-cell lymphoma (ENKTL), a rare subtype of lymphoma with FDG avid character. In this article, a case of nasal type ENKTL is presented and the clinical presentation, diagnosis, treatment and general outcome of this disease are discussed. A 72-year-old Taiwanese male suffered from a nasal obstruction for 4 months, left lower leg erythema and swelling with intermittent fever for 1 week; besides, there was no remarkable finding in the X-ray of left leg and head. Antibiotics was given under the suspicion of left leg cellulitis but 3 new erythematous nodules developed where the biopsy of those new skin lesions revealed extra-nodal Natural Killer/T-Cell Lymphoma. The F-18 FDG PET/CT displayed intense uptake in left nasal cavity (SUVmax: 7.6 → 10.64), multiple sites at both sides of diaphragm with bilateral femurs, bilateral tibias and bones of bilateral feet involvement. The biopsy result at the left paranasal sinus mucosa, nasal turbinate and septum were compatible with F-18 FDG PET/CT finding. The final diagnosis was extra-nodal NK/T cell lymphoma, nasal type with subcutaneous, bilateral femurs, bilateral tibias and bones of bilateral feet involvement, stage IV. Disease progressed and the patient died after four-course chemotherapy and palliative radiotherapy. Consequently, it was concluded that F-18 FDG PET/CT is a promising imaging modality for localizing, guiding biopsy, and staging extra-nodal NK/T cell lymphoma.

關鍵字

F-18 FDG ； nasal type extra-nodal NK/T cell lymphoma ； PET/CT

並列摘要

鼻型淋巴結外自然殺手／T-細胞淋巴癌為具有攝取氟化去氧葡萄糖特性之一種罕見淋巴癌，適當治療需要正確診斷及分期；本文描述一位72歲男性病人，表現鼻塞4個月、左腿紅腫合併發燒一周，以抗生素治療左腿蜂窩性組織炎期間發現左小腿有新的病兆產生，病理切片證實為自然殺手／T-細胞淋巴癌，使用氟-18標記去氧葡萄糖正子／電腦斷層掃描揭露其左側鼻腔、橫膈雙側之多處皮下組織、左右股骨、脛骨、足部有多處代謝增加情形；左側鼻竇、鼻甲及鼻中膈切片結果符合F-18 FDG掃描發現，因而證實為第四期鼻型淋巴結外自然殺手／T- 細胞淋巴癌併多處皮下組織及雙下肢骨頭之侵犯；病人因疾病惡化，於接受四次化學治療及姑息放射治療後死亡。F-18 FDG PET/CT掃描，能偵測、引導切片並協助鼻型淋巴結外自然殺手／T-細胞淋巴癌分期。

並列關鍵字

氟-18去氧葡萄糖 ； 淋巴結外自然殺手／T- 細胞淋巴癌 ； 正子斷層掃描