Balogova Sona, Greksak Radoslav, Mizickova Magdalena, Noskovicova Lucia, Babal Pavel, Lukac Ludovit
Department of Nuclear medicine, Faculty of Medicine, Comenius University in Bratislava and St. Elisabeth Oncology Institute, Bratislava, Slovakia.
Nuclear Medicine, GH Tenon-St Antoine and Sorbonne University, Assistance Publique des Hôpitaux de Paris, Paris, France.
Front Nucl Med. 2022 Feb 16;2:804421. doi: 10.3389/fnume.2022.804421. eCollection 2022.
Fludeoxyglucose (F) (FDG) hybrid positron emission tomography/computed tomography (PET/CT) is currently a well-documented tool for diagnosis, staging, and therapeutic follow-up of lymphoma with significant impact on therapeutic decisions.
We reported a case of a 71-year-old woman with diffuse large B-cell lymphoma (DLBCL) of the left gluteal muscles as a possible result of slow centrifugal migration of untreated neurolymphomatosis (NL) of the lumbosacral plexus suggested on FDG PET/CT 4 years ago, when the patient was complaining for weakness and numbness of the left leg, but the proposed biopsy of peripheral nerve was not performed. Four years later, no pathological FDG uptake was present in nerves and lymph nodes, but PET/CT detected multiple FDG-positive infiltrates in the left gluteal muscles, appearing as a continuation of previously involved nerves.
The biopsy of muscular infiltrates confirmed DLBCL.
The therapy was started, and a complete remission was achieved after three lines of treatment.
This case contributes to limited knowledge on development of skeletal muscle lymphoma (SML): It suggests the macroscopically isolated, FDG-positive SML involving more than one muscular compartment as a possible consequence of natural course of untreated primary NL previously revealed by peripheral neuropathy and suspected on FDG PET/CT. This observation further justifies the consideration of implementation of FDG PET/CT into diagnostic algorithm while evaluating the peripheral neuropathy, in which the NL, albeit rare, is a part of differential diagnosis.
氟脱氧葡萄糖（F）（FDG）杂交正电子发射断层扫描/计算机断层扫描（PET/CT）目前是一种有充分文献记载的工具，用于淋巴瘤的诊断、分期和治疗随访，对治疗决策有重大影响。
我们报告了一例71岁女性，左臀肌弥漫性大B细胞淋巴瘤（DLBCL），可能是由于4年前FDG PET/CT提示的腰骶丛未经治疗的神经淋巴瘤（NL）缓慢离心迁移所致，当时患者抱怨左腿无力和麻木，但未进行提议的周围神经活检。四年后，神经和淋巴结未见病理性FDG摄取，但PET/CT在左臀肌中检测到多个FDG阳性浸润灶，表现为先前受累神经的延续。
肌肉浸润活检确诊为DLBCL。
开始治疗，经过三线治疗后实现完全缓解。
该病例有助于增加对骨骼肌淋巴瘤（SML）发展的有限认识：它表明宏观上孤立的、FDG阳性的SML累及多个肌肉间隙，可能是先前由周围神经病变揭示并在FDG PET/CT上怀疑的未经治疗的原发性NL自然病程的结果。这一观察结果进一步证明了在评估周围神经病变时将FDG PET/CT纳入诊断算法的合理性，其中NL虽然罕见，但也是鉴别诊断的一部分。
