PET/CT in Disease Detection and Follow-up of Subcutaneous Involvement in Marginal Zone Lymphoma

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2020-04, Vol.20 (4), p.252-259
• Main Authors: Davidson, Tima, Avigdor, Abraham, Oksman, Yakov, Nissan, Ella, Zlotnick, Maya, Chikman, Bar, Nissan, Johnatan, Goshen, Elinor, Ben-Haim, Simona, Benjamini, Ohad
• Format: Article
• Language: English
• Subjects: Extranodal; Imaging; Low-grade lymphoma; Mucosa-associated lymphoid tissue; Non-Hodgkin lymphoma
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2019.09.611

The value of positron emission tomography/computed tomography (PET/CT) in the staging and assessment of treatment response in marginal zone lymphoma (MZL) lymphomas remains controversial. We investigated radiologic characteristics of subcutaneous MZL as imaged on PET/CT scans. From the records of a single medical center, for the years 2008 and 2017, we identified subcutaneous lesions in PET/CT scans of patients with histopathologically confirmed MZL in sites other than subcutaneous tissue. Of 571 scans of 178 patients, subcutaneous lesions were found in 20 (11%). Lesions were located in soft tissue structures, mainly along the lateral aspects of the buttocks, thighs and lower and upper back areas, the flank, and the shoulders. Median lengths of the long and short axes of the lesions were 2.0 (range, 1.1-6.0) cm and 0.8 (range, 0.3-2.0) cm, respectively. Median standardized maximum uptake value was 2.3 (range, 0.9-7.6). In 12 patients (60%), MZL was diagnosed at an early stage; 15 (75%) had lymph node involvement and 10 (50%) extranodal involvement. One had spleen and 2 had cutaneous involvement; none had gastric findings. The findings of this study support the usefulness of PET/CT in the detection of subcutaneous MZL as well as in staging and treatment decisions. Positron emission tomography/computed tomography (PET/CT) has important value in staging of many non-Hodgkin lymphoma histologies; however, its role in assessment of marginal zone lymphoma (MZL) is controversial. Evaluation of 571 PET/CT scans of 178 patients with MZL revealed subcutaneous lesions in 11% of patients. We characterized their unique and specific PET/CT findings that enhance clinical diagnosis, accurate staging, and follow-up of MZL.