We present a 66-year-old patient complaining for a 2-month history of odinodysphagia. The physical examination showed a hypertrophic palatal tonsil hardened by palpation, a neoplastic lesion in the cavum, and a level II-B palpable left laterocervical adenopathy.

1. AnnalsofClinicalandMedical ISSN 2639-8109
CaseReports Clinical Image
Afectacion Muscular Y Subcutanea En Miembros Inferiores Por
LinfomaDeCelulasDelManto:HallazgosEnImagenesPET-TC
Daniel GJA, Carlos RF*, María LRJ, Mahsa R and Manuel LEJ
Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Spain
1. Clinical Image
We present a 66-year-old patient complaining for a 2-month history of odinodysphagia. The
physical examination showed a hypertrophic palatal tonsil hardened by palpation, a neoplastic
lesion in the cavum, and a level II-B palpable left laterocervical adenopathy. Cavum and amygda-
la biopsy was performed with histological results of Mantle Cell Lymphoma B, positive for DC21,
CD23, B markers (CD20, Pax5), bcl2, cyclin D1; weakly positive for CD43 and CD5 and negative
for CD10, PD-1, with a Ki67 of 20%.
18F-FDG PET-CT study was requested for initial staging, interim and after finishing chemothe-
rapy treatment (CHOP-Rituximab), which showed a complete metabolic response (Figure 1),
proceeding to a consolidation treatment by autologous hematopoietic cellstransplantation.
After 9 months, on physical examination, inguinal adenopathies were palpated. New 18F-FDG
PET-CT was performed, including lower limbs, since the patient reported pain in the lower limbs
(Figure 2), which was pathological with multiple cutaneous-subcutaneous and muscular lesions.
Skin biopsy of one of lesions described on PET-CT was obtained. The result was lymphoid neo-
plasm with positive cells for B markers (CD20, Pax5), bcl2, cyclin D1, weakly positive for CD5
and negative for CD10, CD138 and CD23, with a Ki67 of 80% that confirmed infiltration by
Mantle lymphoma. The patient is currently under treatment with GEMOX (Gemcitabine-Oxa-
liplatin).
Mantle cell lymphoma is a rare lymphoid neoplasm (5-7% of all lymphomas). It is characterized
by translocation t (11; 14) (q13; q32), positivity for CD5, CD19 / 20 and overexpression of cyclin
D1 [1]. Manifesting clinically with adenopathic involvement (75%) and less frequently extrano-
dal (peripheral blood, bone marrow and gastrointestinal) [2], being the involvement of muscle
and cutaneous tissue unusual [3].
This case illustrates the usefulness of PET-CT as a diagnostic tool for staging, response assess-
ment, relapse and biopsy guidance, as well as in the need of in clinically suspicion, direct or
expand the anatomical territory of exploration of the PET-CT study, which in a habitual protocol
would be limited to pelvicterritoryes.
*Corresponding Author (s): Ramos-Font Carlos, Servicio de Medicina Nuclear, Hospital Uni-
versitario Virgen de las Nieves, Avenida de las Fuerzas Armadas 2 18014, Granada, Spain, Citation: Carlos RF, Afectacion Muscular Y Subcutanea En Miembros Inferiores Por Linfoma De Celulas
Tele: +34-958020580, E-mail: carlos.ramos.font.sspa@juntadeandalucia
http://www.acmcasereport.com/
Del Manto: Hallazgos En Imagenes PET-TC. Annals of Clinical and Medical Case Reports. 2020; 3(4): 1-3.
Volume 3 Issue 4- 2020
Received Date: 08 Mar 2020
Accepted Date: 28 Mar 2020
Published Date: 31 Mar 2020

2. Volume 3 Issue4 -2020 Clinical Image
Figure 1: Comparative image showing the 18F-FDG PET-CT studies of initial staging (A), interim (B) and at the end of the treatment (C) in maximum intensity
projection (MIP). The staging PET-CT study (A) shows a hypermetabolic mass at the level of the right amygdala and cavum (maximum SUV of 10.34) and bilateral
axillary, retroperitoneal and bilateral inguinal adenopathies. In the interim study (B) the adenopathies described above are not appreciated and a focus of moderate
metabolic activity persists at the level of the right amygdala. The restaging study after treatment (C) shows a complete response of all the lesions described.
Figure 2: 18F-FDG PET-CT study from orbits to feet, in MIP projection (A) and CT images and PET-CT fusion of lower limbs (B) showing multiple hypermetabolic
lesions at muscular level and in subcutaneous cellular tissue in both limbs (SUVmax 12, 84). There are two hypermetabolic foci at the thoracic level (A), on cardiac
territory, which in the CT images sits on fat tissue. They were assumed as physiological brown fat tissue uptake. This finding was confirmed by echocardiography that
was normal.
Copyright ©2020 Carlos RF et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, 2
which permits unrestricted use, distribution, and build upon your work non-commercially.

3. Volume 3 Issue 4-2020 Case Report
References
1. Dreyling M, Campo E, Hermine O, Jekerman M, Le Gouill S, Rule S,
et al. Newly diagnosed and relapsed mantle cell lymphoma: ESMO
clinical practice guidelines. Ann Oncol.2017;28(suppl 4):iv62-iv71.
Doi:10.1093/annonc/mdx223.
2. Cheach CY, Seymour JF, Wang ML. Mantle cell lymphoma. J Clin
Oncol. 2016; 34: 1256-69. doi:10.1200/JCO.2015.63.5904.
3. Hod N, Levin D, Anconina R, Ezroh D, Lantsberg S. 18F-FDG
PET/CT in intramuscular mantle cell lymphoma with elongated
lymphomatous neurovascular extensión. Clin Nucl Med. 2019; 44:
e298-e300. doi:10.1097/RLU.0000000000002466
http://www.acmcasereport.com/ 3