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FDG-PET in mantle cell lymphoma involving skin / Deri tutulumlu mantle hucreli lenfomada FDG-PET.

A 61-year-old female patient presents to the hospital with fatigue and weakness. Physical examination was unremarkable except for pallor. White blood cell count (WBC) was 40.500/[micro]L with 62% blast. Hemoglobin (Hgb) level was 7.4g/dl and platelet (PIt) count was 146.000/[micro]L. Bone marrow examination revealed hypercellular marrow and infiltration with blast cells (Figure 1). Blastic cells expressed CD45, CD79a, CD19, CD20, CD5, and cyclin D1 with no expression of CD23. Other laboratory investigations including urea, electrolytes and liver function tests were all in normal limits. No abnormality was detected by computed tomography (CT) scans of neck, thorax, abdomen, and pelvis except splenomegaly (150 mm). Based on the findings, the diagnosis of blastoid variant of mantle cell lymphoma (MCL) was established. She received the CHOP chemotherapy regimen (Cylophosphamide-Doxorubicin-Prednisone-Vincristine) combined with rituximab and achieved complete remission. Ten months later, under routine follow-up, multiple reddish nodules on the back and upper extremities, and trunk were observed (Figure 2). Laboratory parameters, bone marrow examination, and CT scans were normal. Skin lesion biopsy revealed MCL (Figure 3). Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan, which was performed to determine the stage of the skin involvement, showed multiple areas of abnormal uptake in skin (Figure 4).





MCL commonly involves extranodal sites. Skin involvement occurs in only 2%-6% of all cases of MCL but is seen in 17% of stage IV patients. The blastoid types MCL are more aggressive than MCL and associated with a worse clinical outcome. Only a few cases with blastoid variant MCL and skin involvement have been described in English literature. In MCL, FDG-PET detects more disease sites, nodal as well as extranodal, than conventional imaging methods, resulting in a higher sensitivity (1-3).

Written informed consent was obtained from the patient.

Conflict of Interest

No author of this paper has a conflict of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included in this manuscript.

Address for Correspondence: M.D. Mehmet Sonmez, Department of Hematology, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey Phone: +90 462 377 58 48 E-mail:


(1.) Hutchings M, Specht L. PET/CT in the management of haematological malignancies. Eur J Haematol. 2008;80:369-80.

(2.) Estrozi B, Sanches JA Jr, Varela PC, Bacchi CE. Primary cutaneous blastoid mantle cell lymphoma-case report. Am J Dermatopathol. 2009;31:398-400.

(3.) Motegi S, Okada E, Nagai Y, Tamura A, Ishikawa 0. Skin manifestation of mantle cell lymphoma. Eur J Dermatol. 2006;16:435-8.

Mehmet Sonmez (1), Umit Cobanoglu (2), Savas Karyagar (3), Bircan Sonmez (4)

(1) Department of Hematology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey

(2) Department of Pathology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey

(3) Department of Nuclear Medicine, Trabzon Numune Training and Research Hospital, Trabzon, Turkey

(4) Department of Nuclear Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey

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Title Annotation:Images in Hematology
Author:Sonmez, Mehmet; Cobanoglu, Umit; Karyagar, Savas; Sonmez, Bircan
Publication:Turkish Journal of Hematology
Date:Dec 1, 2010
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