Case of a CD3 Negative Hepatosplenic T-Cell Lymphoma: Diagnostic and Therapeutic Challenges

Figure 4

Pet scan 4 weeks after 6 cycles of DA-EPOCH showed massive splenomegaly. The spleen measures up to 27.7 cm in length with pronounced hypermetabolic activity throughout the spleen with a maximal SUV of up to 9.8. There are new peripheral wedge-shaped areas of photopenia consistent with infarcts. There is a pronounced mass effect on the stomach and left kidney from the massive splenomegaly. There is ongoing hepatomegaly as well, with the right hepatic lobe measuring 23.1 cm in length compared to 22.0 previously. Hepatic radiotracer uptake is homogenous but decreased from what would normally be expected (the average maximum SUV is approximately 1.9). This diffusely reduced radiotracer uptake could be secondary to a sequestration of radiotracer in the spleen. The previously described area of low-grade uptake in the left parapharyngeal soft tissues now demonstrates a maximal SUV of 2.0, previously 3.5.