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
Funding: None.
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.