The Importance of F-18 FDG PET/CT in Guiding Biopsy and Initial Staging of Nasal Type Extra-Nodal Natural Killer/T-Cell Lymphoma: A Case Report

摘要

Correct diagnosis and staging leads the proper treatment in nasal type extra-nodal natural killer/ T-cell lymphoma (ENKTL), a rare subtype of lymphoma with FDG avid character. In this article, a case of nasal type ENKTL is presented and the clinical presentation, diagnosis, treatment and general outcome of this disease are discussed. A 72-year-old Taiwanese male suffered from a nasal obstruction for 4 months, left lower leg erythema and swelling with intermittent fever for 1 week; besides, there was no remarkable finding in the X-ray of left leg and head. Antibiotics was given under the suspicion of left leg cellulitis but 3 new erythematous nodules developed where the biopsy of those new skin lesions revealed extra-nodal Natural Killer/T-Cell Lymphoma. The F-18 FDG PET/CT displayed intense uptake in left nasal cavity (SUVmax: 7.6 —>10.64), multiple sites at both sides of diaphragm with bilateral femurs, bilateral tibias and bones of bilateral feet involvement. The biopsy result at the left paranasal sinus mucosa, nasal turbinate and septum were compatible with F-18 FDG PET/CT finding. The final diagnosis was extra-nodal NK/T cell lymphoma, nasal type with subcutaneous, bilateral femurs, bilateral tibias and bones of bilateral feet involvement, stage IV. Disease progressed and the patient died after four-course chemotherapy and palliative radiotherapy. Consequently, it was concluded that F-18 FDG PET/CT is a promising imaging modality for localizing, guiding biopsy, and staging extra-nodal NK/T cell lymphoma.