PMC3304513_01
Contrast PET/CT. a, b Abnormal uptake of FDG demonstrated the presence of tumor in the numerous mediastinal lymph nodes and in the heart. c, d On day 37 after the introduction of chemotherapy, FDG uptake had virtually disappeared.
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F1
On day 37, PET/CT imaging showed partial remission of the residual tumor (fig. 1), although the patient's WBC count remained above 3.0 x 109/l.
Contrast-enhanced CT. a, b After the initial treatment, there were no abnormal findings. c, d In January 2011, there was a swelling of the mediastinal lymph nodes and an abnormal mass in the right ventricular wall. e, f On day 112 after the introduction of salvage chemotherapy, no swelling of the mediastinal lymph nodes was detected and the abnormal cardiac mass was diminished in size.
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F2
CT (fig. 2). Cardiac MRI revealed the presence of abnormal masses in the right ventricular wall together with an infiltration of the right atrium, aortic root, and tricuspid valve (fig. 3). On day 112, enhanced CT imaging showed a remarkable reduction in size of the numerous mediastinal lymph nodes together with near disappearance of the cardiac tumor (fig. 2).
Contrast cardiac MRI. a, b Abnormal mass in the right ventricular wall invading the right atrium, aortic root, and tricuspid valve. c, d On day 18 after the introduction of chemotherapy, the cardiac tumor remained, but had decreased in size.
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F3
CT (fig. 2). Cardiac MRI revealed the presence of abnormal masses in the right ventricular wall together with an infiltration of the right atrium, aortic root, and tricuspid valve (fig. 3). Within one week, almost all of the forehead papules regressed, and on day 18 the metastatic cardiac tumor was also markedly reduced in size (fig. 3).
Patient progress during treatment. The PEP-C regimen consisted of daily oral administration of prednisone 20 mg after breakfast, cyclophosphamide 50 mg after lunch, etoposide 50 mg after dinner, and procarbazine 50 mg at bedtime. The dosing frequency in the maintenance phase comprised administration for 14 consecutive days with a one-week rest, with the medications and doses given per day held constant according to the introduction of the PEP-C regimen. The frequency of Rit administration was tri-weekly from day 22. LDH = Lactic dehydrogenase (IU/l); sIL-2R = interleukin 2 receptor, soluble (U/ml).
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F4
This treatment consisted of daily oral administration of prednisone 20 mg after breakfast, cyclophosphamide 50 mg after lunch, etoposide 50 mg after dinner, and procarbazine 50 mg at bedtime, and it was continued until the white blood cell (WBC) count dropped below 3.0 x 109/l (fig. 4). At this stage, CD20 antigen expression remained and residual tumor was apparent, prompting the start of a new combined therapy of Rit plus the PEP-C regimen from day 22 (fig. 4).