Reyneke Florette, Mokgoro Neo, Vorster Mariza, Sathekge Mike
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa.
Medicine (Baltimore). 2017 Nov;96(46):e8687. doi: 10.1097/MD.0000000000008687.
Burkitt lymphoma (BL) is a type of non-Hodgkin lymphoma that arises in the B-cells. Cavernous sinus involvement is rare, especially in adults. Here we report an unusual case of a 30-year-old HIV-positive woman with BL and cavernous sinus syndrome who also had intense bilateral breast uptake, related to menstrual cycle. Fluorine-18 2-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been found to be useful in the management of BL.
A 30-year old female patient presented with a history of diplopia and headache.
Magnetic resonance imaging revealed a large cavernous sinus mass. A bone marrow biopsy was done and demonstrated extensive marrow infiltration by Burkitt lymphoma. Further investigation detected the Epstein-Barr virus in her cerebrospinal fluid using qualitative polymerase chain reaction. 18F-FDG PET/CT imaging done revealed a hypermetabolic cavernous sinus mass, conglomerates of enlarged pelvic and para-aortic lymph nodes as well as diffuse bone marrow uptake. Intense bilateral breast uptake was noted coinciding with the start of menses.
She was started on chemotherapy with adjuvant radiotherapy.
After her first cycle of chemotherapy, repeat 18F-FDG PET/CT imaging revealed a marked reduction in the metabolic activity and size of the cavernous sinus mass and conglomerates of lymph nodes. The bone marrow activity was still visualized but less intense compared to the staging PET/CT.
A cavernous sinus mass will rarely be the primary lesion in Burkitt's Lymphoma. Our case demonstrates the role of 18F-FDG PET/CT in the assessment of such cases to detect other primary areas of disease involvement. It is useful in accurate initial staging and monitoring of treatment response in patients with Burkitt's Lymphoma.
伯基特淋巴瘤（BL）是一种起源于B细胞的非霍奇金淋巴瘤。海绵窦受累罕见，尤其是在成人中。在此，我们报告一例不寻常的病例，一名30岁的HIV阳性女性患有BL并伴有海绵窦综合征，其双侧乳房摄取也增强，与月经周期有关。已发现氟-18 2-氟-2-脱氧葡萄糖（18F-FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在BL的管理中有用。
一名30岁女性患者出现复视和头痛病史。
磁共振成像显示海绵窦有一个大肿块。进行了骨髓活检，结果显示伯基特淋巴瘤广泛浸润骨髓。进一步检查使用定性聚合酶链反应在其脑脊液中检测到爱泼斯坦-巴尔病毒。18F-FDG PET/CT成像显示海绵窦肿块代谢活跃，盆腔和主动脉旁淋巴结肿大融合以及骨髓弥漫性摄取。注意到双侧乳房摄取增强与月经开始时间一致。
她开始接受化疗并辅助放疗。
在她的第一个化疗周期后，重复18F-FDG PET/CT成像显示海绵窦肿块和淋巴结融合的代谢活性和大小明显降低。骨髓活性仍可见，但与分期PET/CT相比强度较低。
海绵窦肿块很少会是伯基特淋巴瘤的主要病变。我们的病例证明了18F-FDG PET/CT在评估此类病例以检测其他疾病受累的主要区域中的作用。它在伯基特淋巴瘤患者的准确初始分期和治疗反应监测中很有用。
