Multimodality Appearances of Marginal Zone Lymphoma Masquerading as Cryptogenic Organizing Pneumonia-serial Chest Radiograph and High-resolution Computed Tomography Appearances: (18F) Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging Utility

Elizabeth Robinson; Ayah Nawwar; Julie Searle; Iain Lyburn

doi:10.4103/ijnm.ijnm_83_23

Multimodality Appearances of Marginal Zone Lymphoma Masquerading as Cryptogenic Organizing Pneumonia-serial Chest Radiograph and High-resolution Computed Tomography Appearances: (¹⁸F) Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging Utility

Indian J Nucl Med. 2023 Oct-Dec;38(4):400-401. doi: 10.4103/ijnm.ijnm_83_23. Epub 2023 Dec 20.

Authors

Elizabeth Robinson^{1

2}, Ayah Nawwar^{1

2

3

4}, Julie Searle^{1

2}, Iain Lyburn^{1

2

5}

Affiliations

¹ Medical Imaging Centre, Cobalt Medical Charity, Cheltenham, UK.
² Department of Radiology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK.
³ Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
⁴ Department of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt.
⁵ Cranfield Forensic Institute, Cranfield University, Wiltshire, UK.

Abstract

Marginal zone lymphoma (MZL) is a group of low-grade, indolent, non-Hodgkin lymphomas rarely manifesting in the lungs. A 46-year-old man presenting with shortness of breath and cough was investigated and treated over 10 months for an atypical pattern of lung disease in keeping with cryptogenic organizing pneumonia (COP). Initial lung biopsies were nondiagnostic - repeat sampling eventually showed MZL. Staging whole-body (¹⁸F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) demonstrated multisystem stage IV disease with intensely avid widespread pulmonary changes resembling COP. The case elegantly illustrates that pulmonary MZL can present insidiously masquerading as COP and shows the value of (¹⁸F) FDG PET/CT to stage extranodal MZL.

Keywords: Fluorodeoxyglucose positron emission tomography/computed tomography; marginal zone lymphoma; organizing pneumonia.