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Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease

Follicular lymphoma is clinically classified as a common type of indolent non-Hodgkin's lymphoma, and its clinical diagnosis is difficult because B symptoms and elevated soluble interleukin-2 receptor (sIL-2R) levels are less frequent in follicular lymphoma than in other lymphomas. We report a...

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Autores principales: Ishizuka, Kosuke, Shikino, Kiyoshi, Yokokawa, Daiki, Ikusaka, Masatomi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350010/
https://www.ncbi.nlm.nih.gov/pubmed/34401019
http://dx.doi.org/10.1016/j.radcr.2021.07.008
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author Ishizuka, Kosuke
Shikino, Kiyoshi
Yokokawa, Daiki
Ikusaka, Masatomi
author_facet Ishizuka, Kosuke
Shikino, Kiyoshi
Yokokawa, Daiki
Ikusaka, Masatomi
author_sort Ishizuka, Kosuke
collection PubMed
description Follicular lymphoma is clinically classified as a common type of indolent non-Hodgkin's lymphoma, and its clinical diagnosis is difficult because B symptoms and elevated soluble interleukin-2 receptor (sIL-2R) levels are less frequent in follicular lymphoma than in other lymphomas. We report a case of follicular lymphoma masquerading immunoglobulin G4-related disease (IgG4-RD) with elevated IgG4 levels. A 67-year-old man presented to our hospital with a 1-year history of deep right supraclavicular and para-aortic lymph node lymphadenopathy on plain computed tomography (CT) findings along with elevated IgG4 levels, and the (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan showed heterogeneous diffuse FDG uptake in the liver, and FDG uptake was noted at multiple sites in the enlarged right supraclavicular and para-aortic lymph nodes. Excisional biopsy of the right supraclavicular lymph node, performed under general anesthesia, showed a tumor-like structure mimicking a normal germinal center in the lymphoid follicle; immunostaining was positive for B-cell lymphoma 2 and CD10 proteins with some plasma cells stained with IgG, only 30% of them were positive for IgG4, and no marked fibrosis characteristic of IgG4-RD was observed; therefore, follicular lymphoma was diagnosed, and all symptoms, including FDG uptake, improved with rituximab monotherapy. Differential diagnoses of slowly progressive generalized lymphadenopathy over the years with elevated serum IgG4 levels include IgG4-RD, Castleman's disease, and indolent lymphoma. Multiple accumulation in the liver on FDG-PET/CT, if found, may suggest indolent lymphoma among them.
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spelling pubmed-83500102021-08-15 Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease Ishizuka, Kosuke Shikino, Kiyoshi Yokokawa, Daiki Ikusaka, Masatomi Radiol Case Rep Case Report Follicular lymphoma is clinically classified as a common type of indolent non-Hodgkin's lymphoma, and its clinical diagnosis is difficult because B symptoms and elevated soluble interleukin-2 receptor (sIL-2R) levels are less frequent in follicular lymphoma than in other lymphomas. We report a case of follicular lymphoma masquerading immunoglobulin G4-related disease (IgG4-RD) with elevated IgG4 levels. A 67-year-old man presented to our hospital with a 1-year history of deep right supraclavicular and para-aortic lymph node lymphadenopathy on plain computed tomography (CT) findings along with elevated IgG4 levels, and the (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan showed heterogeneous diffuse FDG uptake in the liver, and FDG uptake was noted at multiple sites in the enlarged right supraclavicular and para-aortic lymph nodes. Excisional biopsy of the right supraclavicular lymph node, performed under general anesthesia, showed a tumor-like structure mimicking a normal germinal center in the lymphoid follicle; immunostaining was positive for B-cell lymphoma 2 and CD10 proteins with some plasma cells stained with IgG, only 30% of them were positive for IgG4, and no marked fibrosis characteristic of IgG4-RD was observed; therefore, follicular lymphoma was diagnosed, and all symptoms, including FDG uptake, improved with rituximab monotherapy. Differential diagnoses of slowly progressive generalized lymphadenopathy over the years with elevated serum IgG4 levels include IgG4-RD, Castleman's disease, and indolent lymphoma. Multiple accumulation in the liver on FDG-PET/CT, if found, may suggest indolent lymphoma among them. Elsevier 2021-08-01 /pmc/articles/PMC8350010/ /pubmed/34401019 http://dx.doi.org/10.1016/j.radcr.2021.07.008 Text en © 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Ishizuka, Kosuke
Shikino, Kiyoshi
Yokokawa, Daiki
Ikusaka, Masatomi
Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease
title Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease
title_full Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease
title_fullStr Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease
title_full_unstemmed Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease
title_short Follicular lymphoma with hepatic accumulation on FDG-PET/CT masquerading IgG4-related disease
title_sort follicular lymphoma with hepatic accumulation on fdg-pet/ct masquerading igg4-related disease
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350010/
https://www.ncbi.nlm.nih.gov/pubmed/34401019
http://dx.doi.org/10.1016/j.radcr.2021.07.008
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