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Austin J Radiol. 2018; 5(2): 1084.
Sarcoid-Like Reaction after Lymphoma Treatment
Choudhary G¹*, Chokr J² and Jagpal A³
¹Department to Radiology, University of Alabama at Birmingham, USA
²Department of Radiology, Clemenceau Medical Center, Lebanon
³Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, USA
*Corresponding author: Choudhary G, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South Birmingham, AL 35249-6835, USA
Received: November 23, 2018; Accepted: November 29, 2018; Published: December 06, 2018
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A 58-year-old woman with diffuse large B-cell lymphoma was treated with 6 cycles of chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone). Post therapy PET scan showed no metabolically active disease (Figure 1). A year later, routine follow up PET scan showed new hypermetabolic mediastinal and bilateral hilar lymph nodes (Figure 2). Patient underwent excisional biopsy of the right paratracheal lymph node which showed noncaseating granulomatous inflammation with no morphologic or immunohistochemical evidence of lymphoma. Diagnosis of Sarcoid- Like Reaction (SLR) was made.
Sarcoid like reactions have been observed in variety of malignancies, including breast, lung and lymphoma. Pathophysiology of SLR is not well understood, however excessive immune response against the lymphoma cells has been postulated. Patients who develop SLR after chemotherapy appear to have favorable longterm prognosis. SLRs may have intense uptake on the PET scan and differentiating it from recurrence of malignancy can be difficult based on imaging alone. Tissue biopsy is often required if relapse is suspected [1,2].
Figure 1: Maximum intensity image (MIP) after completion of chemotherapy.
No abnormal uptake seen to suggest residual or recurrent lymphoma.
Figure 2: Follow up maximum intensity image (MIP) one year after completion
of chemotherapy. Abnormal uptake seen in bilateral hilar and right para
tracheal region (arrows).
References
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