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Biomed Imaging Interv J 2008; 4(1):e6
doi: 10.2349/biij.4.1.e6
© 2008 Biomedical Imaging and Intervention Journal


PDF version Case Report

F18 fluorodeoxyglucose uptake in progressive transformation of germinal centres

B Rehani*MD, Y Dowdy, MD, A Bharija, MD, P Strohmeyer, RN, J Mantil, MD

Department of Internal Medicine, Kettering Medical Center, Ohio, United States

Abstract

FDG-PET/CT is a widely established imaging modality for staging, restaging and monitoring therapy response in lymphoma patients. Progressive transformation of germinal centres (PTGC) is a benign condition presenting characteristically as asymptomatic lymphadenopathy. This paper presents a case of a 53-year-old man with a history of Hodgkin�s disease (HD) whose F18 FDG-PET/CT scan showed high uptake in left axillary lymph nodes (SUV 3.8). A subsequent, left axillary lymph node biopsy revealed PTGC. PTGC can present as a false positive finding on FDG-PET/CT in lymphoma patients and biopsy should be done in HD patients in clinical remission but have a positive FDG-PET/CT scan. � 2008 Biomedical Imaging and Intervention Journal. All rights reserved.

Keywords: F18 FDG-PET/CT, Progressive Transformation of Germinal centres (PTGC), Hodgkin�s disease (HD)

Case Report

A 53-year-old man underwent FDG-PET/CT scanning for detection of recurrent disease. He was diagnosed with Hodgkin�s disease (HD) five years ago and successfully treated with chemotherapy. The patient was asymptomatic. 12.6 mCi FDG was injected and images acquired using a Siemens Biograph 6 PET-CT scanner (Siemens AG, Munich) (Figure 1). The PET/CT image showed small lymph nodes in the left axilla with the highest standardised uptake value of 3.8 and measuring less than 1 cm in size. FDG-PET/CT imaging has been found to have higher accuracy than FDG-PET and CT alone in staging and restaging of patients with lymphoma [1,2].

Left axillary lymph node biopsy was performed and revealed progressive transformation of germinal centres (PTGC). Figure 2a shows progressive transformed germinal centre and loss of normal architecture, while Figure 2b shows small lymphocytes, histiocytes and immunoblasts.

Discussion

PTGC was initially described by Lennert and Muller Hermerlink as large follicles composed predominantly of diffuse small lymphocytes and an obscured mantle zone [3]. PTGC is most commonly seen in lymph nodes in association with reactive follicular hyperplasia [4]. PTGC may precede lymphocyte predominant Hodgkin�s disease (LPHD) or can be present subsequently in lymph node biopsies of lymphoma patients as seen in this case; but the presence of PTGC is not associated definitively with an increased risk of developing HD [5].

The causes of false positive FDG-PET/CT include infection, inflammation, granulomatous disease [6,7] and immunisation [8]. However, the FDG uptake in PTGC has been rarely documented in literature [9] and can present as a false positive finding on FDG-PET/CT scan.

Figure 1 FDG PET-CT scan of the patient. Arrow shows small lymph nodes in the left axilla with the highest standardised uptake value of 3.8 and measuring less than 1 cm in size.

Figure 2 Photomicrograph of left axillary lymph node biopsy (a) shows progressive transformed germinal centre and loss of normal architecture (haematoxylin and eosin stain, x10); (b) shows small lymphocytes, histiocytes and immunoblasts (haematoxylin and eosin stain, x40).

References

  1. Freudenberg LS, Antoch G, Schutt P et al. FDG-PET/CT in re-staging of patients with lymphoma. Eur J Nucl Med Mol Imaging 2004; 31(3):325-9.   [Medline] [CrossRef]
  2. Allen-Auerbach M, Quon A, Weber WA et al. Comparison between 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography and positron emission tomography/computed tomography hardware fusion for staging of patients with lymphoma. Mol Imaging Biol 2004; 6(6):411-6.   [Medline] [CrossRef]
  3. Lennert K, Muller-Hermelink HK. [Lymphocytes and their functional forms - morphology, organization and immunologic significance]. Verh Anat Ges 1975; 69:19-62.   [Medline]
  4. Kojima M, Nakamura S, Motoori T et al. Progressive transformation of germinal centers: a clinicopathological study of 42 Japanese patients. Int J Surg Pathol 2003; 11(2):101-7.   [Medline]
  5. Chang CC, Osipov V, Wheaton S et al. Follicular hyperplasia, follicular lysis, and progressive transformation of germinal centers. A sequential spectrum of morphologic evolution in lymphoid hyperplasia. Am J Clin Pathol 2003; 120(3):322-6.   [Medline] [CrossRef]
  6. Castellucci P, Zinzani P, Pourdehnad M et al. 18F-FDG PET in malignant lymphoma: significance of positive findings. Eur J Nucl Med Mol Imaging 2005; 32(7):749-56.   [Medline] [CrossRef]
  7. Barrington SF, O'Doherty MJ. Limitations of PET for imaging lymphoma. Eur J Nucl Med Mol Imaging 2003; 30 Suppl 1:S117-27.   [Medline] [CrossRef]
  8. Williams G, Joyce RM, Parker JA. False-positive axillary lymph node on FDG-PET/CT scan resulting from immunization. Clin Nucl Med 2006; 31(11):731-2.   [Medline] [CrossRef]
  9. Grigg A, Ganju V. PET positive progressive transformation of germinal centers masquerading as relapsed Hodgkin lymphoma post-autograft. Leuk Lymphoma 2006; 47(4):764-5.   [Medline]

Received 9 December 2007; accepted 3 January 2008

Correspondence: Department of Internal Medicine, Kettering Medical Center, 3535 Southern Blvd., Dayton, Ohio 45429, United States. Tel.: 937-395-8611; Fax: 937-395-8365; E-mail: bhavya.rehani@kmcnetwork.org (Bhavya Rehani).

Please cite as: Rehani B, Dowdy Y, Bharija A, Strohmeyer P, Mantil J, F18 fluorodeoxyglucose uptake in progressive transformation of germinal centres, Biomed Imaging Interv J 2008; 4(1):e6
<URL: http://www.biij.org/2008/1/e6/>

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University of Malaya, Kuala Lumpur, Malaysia

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