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Incremental Value of FDG PET/CT in Aggressive High Grade B Cell lymphoma with TdT Expression

Authors
  • Sampathirao, Nikita1
  • Muthukrishnan, Indirani1
  • Kurian, Ann2
  • Amalchandran, Jaykanth1
  • Patel, Asra1
  • Mathew, Shema1
  • Simon, Shelley1
  • 1 Department of Nuclear Medicine and PET/CT, Apollo Hospitals, Chennai, India
  • 2 Department of Pathology, Apollo Hospitals, Chennai, India
Type
Published Article
Journal
Asia Oceania Journal of Nuclear Medicine and Biology
Publisher
Mashhad University of Medical Sciences
Publication Date
Jan 01, 2021
Volume
9
Issue
1
Pages
45–50
Identifiers
DOI: 10.22038/AOJNMB.2020.48887.1332
PMID: 33392349
PMCID: PMC7701230
Source
PubMed Central
Keywords
License
Unknown

Abstract

High-grade B-cell lymphoma, an aggressive form of Non-Hodgkin’s Lymphoma, is known as a double or triple hit lymphoma based on the presence of MYC and BCL2 without or with BCL6 genetic rearrangements, respectively. It carries a poorer prognosis, compared to other variants of B-cell lymphoma, and its management also differs which requires more intensive chemotherapy in contrast to the routine regimen. Terminal deoxynucleotidyl transferase (TdT), a marker of immaturity is commonly expressed in B-cell lymphoblastic leukemia or lymphoma (B cell ALL) which is absent in mature forms of B-cell lymphoma. The TdT is expressed in high-grade B-cell lymphoma; therefore, it poses a classification and management dilemma, which should be accurately differentiated from B-cell ALL and mandates molecular analysis. Herein, we report a case of a 52-year-old female with biopsy reported as high-grade B-cell lymphoma with TdT expression. She was referred for Fluor-deoxyglucose (FDG) Positron Emission Tomography-Computed Tomography (PET/CT) scan for staging in the absence of molecular analysis for B-cell ALL. It was diagnosed as lymphoma on FDG PET/CT based on its characteristic findings of extensive extranodal involvement of multiple organs with no significant lymphadenopathy establishing the incremental value of FDG PET/CT scan, which helped the clinician to arrive at a conclusion.

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