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July 02, 2013; 81 (1) Resident and Fellow Section

Teaching NeuroImages: Diagnostic utility of FDG-PET in neurolymphomatosis

Michel Toledano, Mustaqeem A. Siddiqui, Carrie A. Thompson, Ivan Garza, Sean J. Pittock
First published July 1, 2013, DOI: https://doi.org/10.1212/WNL.0b013e318297eef5
Michel Toledano
From the Department of Neurology (M.T., I.G., S.J.P.), Division of Hospital Internal Medicine, Internal Medicine (M.A.S.), and Department of Hematology (C.A.T.), Mayo Clinic, Rochester, MN.
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Mustaqeem A. Siddiqui
From the Department of Neurology (M.T., I.G., S.J.P.), Division of Hospital Internal Medicine, Internal Medicine (M.A.S.), and Department of Hematology (C.A.T.), Mayo Clinic, Rochester, MN.
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Carrie A. Thompson
From the Department of Neurology (M.T., I.G., S.J.P.), Division of Hospital Internal Medicine, Internal Medicine (M.A.S.), and Department of Hematology (C.A.T.), Mayo Clinic, Rochester, MN.
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Ivan Garza
From the Department of Neurology (M.T., I.G., S.J.P.), Division of Hospital Internal Medicine, Internal Medicine (M.A.S.), and Department of Hematology (C.A.T.), Mayo Clinic, Rochester, MN.
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Sean J. Pittock
From the Department of Neurology (M.T., I.G., S.J.P.), Division of Hospital Internal Medicine, Internal Medicine (M.A.S.), and Department of Hematology (C.A.T.), Mayo Clinic, Rochester, MN.
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Citation
Teaching NeuroImages: Diagnostic utility of FDG-PET in neurolymphomatosis
Michel Toledano, Mustaqeem A. Siddiqui, Carrie A. Thompson, Ivan Garza, Sean J. Pittock
Neurology Jul 2013, 81 (1) e3; DOI: 10.1212/WNL.0b013e318297eef5

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A 70-year-old woman with a history of non-Hodgkin lymphoma presented with left-sided facial pain. MRI of the face, orbit, and neck was negative (figure). A week later, she developed hypesthesia in a V3 distribution. Repeat MRI was again nondiagnostic but fluorodeoxyglucose (FDG)-PET showed increased uptake along the left V3 branch of the trigeminal nerve, as well as in the parotid gland. Biopsy of the left parotid confirmed recurrent lymphoma.

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Figure Face, orbit, and neck imaging

Axial MRI T1 gadolinium images without any contrast enhancement at the level of the trigeminal nerve (A) or parotid gland (D). PET reveals a focus of intense fluorodeoxyglucose (FDG) avidity extending through the foramen ovale along the course of the left V3 branch of the trigeminal nerve in both axial (B) and coronal (C) cuts, consistent with perineural spread of disease. Axial (E) and coronal (F) cuts show increased FDG activity in the left parotid gland.

Neurolymphomatosis is a rare manifestation of hematologic disease and diagnosis is often delayed.1 Our case illustrates the utility of FDG-PET in establishing the diagnosis of neurolymphomatosis when suspicion is high but MRI is unrevealing.2

AUTHOR CONTRIBUTIONS

Drs. Toledano, Garza, and Pittock made substantive contributions to the design of the study and drafting of the manuscript. Drs. Siddiqui and Thompson made substantive contributions to the revision of the manuscript.

STUDY FUNDING

No targeted funding reported.

DISCLOSURE

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Footnotes

  • Download teaching slides: www.neurology.org

  • © 2013 American Academy of Neurology

REFERENCES

  1. 1.↵
    1. Grisariu S,
    2. Avni B,
    3. Batchelor TT,
    4. et al
    . Neurolymphomatosis: an International Primary CNS lymphoma Collaborative Group report. Blood 2010;115:5005–5011.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Salm LP,
    2. Van der Hiel B,
    3. Stokkel MP
    . Increasing importance of 18F-FDG PET in the diagnosis of neurolymphomatosis. Nucl Med Commun 2012;33:907–916.
    OpenUrlCrossRefPubMed
View Abstract

Disputes & Debates: Rapid online correspondence

  • MRI is of great value in diagnosis of neurolymphomatosis
    • Le Song, doctor, The Department of Nuclear Medicine, Peking University Third Hospitalsongle1983@qq.com
    Submitted July 15, 2013
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