PMC9961566_01
Histopathology.
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Using the in-situ hybridization (ISH), the Epstein-Barr encoding region (EBER) came positive (Figure 1).
FDG PET/CT maximum intensity projection (left column) and fused PET and CT transaxial images (right column) from the lower neck region.
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The FDG PET scan showed intense uptake (SUVmax 29.6) in an irregular infiltrative mass on the right side of the neck with a 20 cm maximum diameter (Metabolic tumor volume (MTV) 894 cm3) with no evidence of increased uptake in other regions (Figure 2A). Post-chemotherapy FDG PET scan showed significantly decreasing extent and uptake of right cervical lymphomatous mass overall, considered as a partial response (now with 5x4.5 maximum diameters and >50% SUVmax decreased uptake) with still residual uptake in right supraclavicular lymph nodes (SUVmax of 8.4) (Figure 2B). A follow-up FDG PET scan showed newly developed hypermetabolic lesions in the right neck and upper thorax area, suspicious of lymphoma manifestation (Figure 2C). After three cycles, an FDG PET scan showed uptake in the previously seen right lower neck and thoracic inlet lesions; however, MTV reduced from 57.6 cm3 to 2.8 cm3(Figure 2D). Then the FDG PET scan was repeated after completing six cycles of PBR protocol and showed further decreasing uptake in the previous lesions with no new ones (MTV 2.2 cm3) (Figure 2E).