Discordance between positron emission tomography standard uptake value and proliferation index in mantle cell lymphoma: An initial communication

[摘要] An 80-year-old male complained of rapidly enlarging neck lymphadenopathy. Following ultrasound-guided biopsy, mantle celllymphoma (MCL) was diagnosed. Staging fluorodeoxyglucose (FDG)-positron emission tomography (PET) demonstrated avid supra- andinfra-diaphragmatic adenopathy. However, PET showed striking heterogeneity of standard uptake value maximum (SUVmax; Figure 1, leftdisplay): the biopsied cervical node (28 mm) had a moderate SUVmaxof 5.5, whereas a peripancreatic node (35 mm) had an intense SUVmax of 11.5. A watchful waiting strategy had been advocated based on thelow proliferation index of the biopsied neck node. However, the highSUVmax of the abdominal node raised concern for high proliferationindex MCL (warranting therapy), therefore additional abdominalbiopsy was undertaken. Histological analysis of both the neck (Figure 1, middle display) and abdominal node (Figure 1, right display)confirmed concordant low proliferation index disease, demonstratingMCL classic morphology (haematoxylin and eosin stained section,400× objective; Figure 1, left panel) that is cyclin D1 positive (Figure1, right upper panel; 400× objective) with a low proliferation index of15% (400× objective).