Case presentation
A 67-year-old man presented with a 1-year history of cervical and para-aortic lymph node lymphadenopathy on plain computed tomography (CT) scan and was referred to our hospital. Physical examination revealed no superficial lymphadenopathy and hepatomegaly. Laboratory tests showed elevated C-reactive protein (CRP, 11.33 mg/dL) and soluble interleukin-2 receptor (sIL-2R, 1010 U/mL) but no other findings including hepatobiliary enzymes. Abdominal ultrasonography showed no abnormalities. The 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan showed multiple sites of FDG uptake in the enlarged cervical (SUVmax, 3.5) and para-aortic lymph nodes (SUVmax, 4.9) (Figure 1). Additionally, diffuse FDG uptake was observed in the liver (SUVmax, 5.7) (Figure 2). Right supraclavicular lymph node biopsy detected follicular lymphoma. Secondary hepatic follicular lymphoma was diagnosed and classified as Lugano system stage IV. Rituximab monotherapy was started. CRP and sIL-2R levels improved. FDG uptake in the enlarged lymph nodes and diffuse FDG uptake in the liver disappeared.
Follicular lymphoma is the second most common type of non-Hodgkin’s lymphoma. Hepatic accumulation observed on FDG-PET/CT, which is the most useful imaging finding, is observed in 15% of cases.1 Secondary hepatic lymphoma is defined based on distant involvement2, and it typically presents as diffuse infiltration, as in this case.2
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Acknowledgements: None.
Author’s Contribution: KI, KS, DY, and MI managed the patient. KI wrote the draft. KS, DY, and MI revised this article. The patient provided consent to report the case.