PMC9899482_01
Sinonasal diffuse large B cell lymphoma in a 74-year-old female. Axial 3D T1 MPRAGE after IV gadolinium administration (a and b) showed asymmetric submucosal enhancement along the medial wall of the right maxillary antrum and within the right retromaxillary space (black arrows). Asymmetric thickening and mass like enhancement of the right V3 nerve at the level of right foramen ovale was noted (white arrow). Coronal (c), and sagittal (d) 3D T1 MPRAGE after IV gadolinium administration confirmed the abnormal thickening and mass enhancement at the right Meckle's cave, right foramen ovale, right masticator space and right retromaxillary spaces (arrows). Axial high-resolution non-contrast CT of the sinuses (e) revealed demineralization and lytic changes of the right maxillary medial wall, corresponding to abnormal enhancement on MRI. Axial fused PET/CT image at the level of maxillary antra (f) confirmed hypermetabolic mass along the right maxillary medial wall.
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F1
MRI showed asymmetric thickening and enhancement of the right V3 nerve with widening of the right foramen ovale and further extension into the lateral margin of the right cavernous sinus [Figure 1]. From the right cavernous sinus, there is notable thickening and enhancement through V2 nerve within foramen rotundum, and pterygopalatine fossa as well as thickening and enhancement of the right infra-orbital nerve [Figure 1]. PET/CT revealed submucosal avid FDG activity within the medial wall of the right maxillary antrum, extending into the right pterygopalatine fossa [Figure 1].
PMC9899482_02
Prevertebral diffuse large B cell lymphoma in a 58-year-old male. Sagittal T2 (a) and T1 with fat saturation after IV gadolinium administration (b) showed large ovoid T2 hyperintense, enhancing mass within the prevertebral space (black arrows). Abnormal bone marrow enhancement of C2 vertebral body, suspicious for osseous origin or infiltration by the soft-tissue mass. Sagittal T1 with fat saturation after IV gadolinium administration also showed significant intraspinal extension with large enhancing mass compressing the spinal cord (white arrow). Axial T1 with fat saturation after IV gadolinium administration (c), and high-resolution non-contrast CT in bone window at the same level (d) confirmed the osseous erosive changes (arrow heads), and large enhancing intraspinal component (white arrows).
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F2
MRI spine revealed a large prevertebral enhancing mass extending into upper cervical spine with circumferential cord compression [Figure 2].
PMC9899482_03
Right buccal marginal zone lymphoma in a 58-year-old male. Coronal (a) and axial (b) contrast enhanced images of the CT neck showed enhancing right buccal submucosal mass with involvement of the inferior gingivobuccal sulcus (arrows).
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F3
CT neck with intravenous (IV) contrast demonstrated a well-circumscribed enhancing mass centered on the right buccal mucosa [Figure 3].
PMC9899482_04
Thyroid marginal zone lymphoma in a 12-year-old female. Axial (a) and coronal (b) contrast enhanced images of the CT neck showed marked diffuse enlargement of the right thyroid lobe with diffuse heterogeneous enhancement and non-discrete masses (arrows). Note left thyroidectomy.
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F4
Thyroid ultrasound revealed a highly heterogeneous appearance of the thyroid gland, without any discrete nodules [Figure 4]. The right lobe measured 6.53 cm in its greatest dimension, and left lobe measured 5.31 cm.
PMC9899482_05
Right parotid diffuse large B cell lymphoma in a 60-year-old female. Axial (a) and sagittal (b) contrast-enhanced images of the CT neck at the level of right parotid gland showed an irregular enhancing mass within the deep lobe of the right parotid gland (arrows). The mass contacts the right retromandibular vein and abuts the inferior wall of right cartilaginous external auditory canal.
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F5
She underwent a CT which showed a right parotid gland heterogeneously enhancing mass without obvious vascular nor mandibular invasion [Figure 5].
PMC9899482_06
Left carotid space diffuse large B cell lymphoma in a 65-year-old male. Coronal T1 (a) and T1 with fat saturation after IV gadolinium administration (b) showed large lobulated mildly enhancing mass within the left carotid space medially displacing and compressing the left internal jugular vein (arrows). The mass has significant predominantly homogeneous restricted diffusion on diffusion weighted image (c), and ADC (d). Axial PET (e), and fused PET/CT (f) images demonstrated significant hypermetabolism of the mass with increased FDG uptake (arrows).
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F6
CT neck was obtained which revealed a well circumscribed oblong shaped enhancing mass within the left carotid space deep to the sternocleidomastoid muscle [Figure 6]. Contrast-enhanced MRI of the neck showed large lobulated mildly enhancing mass within the left carotid space, mildly compressing, and medially displacing the left carotid space vessels, that is, common, and internal carotid arteries as well as internal jugular vein [Figure 6]. The mass showed significant restricted diffusion on diffusion-weighted imaging (DWI) with decreased apparent diffusion coefficient (ADC) value [Figure 6].
PMC9899482_07
Multifocal calvarial, skull base, and facial osseous high-f diffuse large B cell lymphoma in a 24-year-old male. Axial T2 (a) and axial 3D T1 MPRAGE after IV gadolinium administration (b) showed diffuse expansion, thickening and infiltration of the left fronto-temporal calvarial bones, associated with extra-cranial and intracranial enhancing masses (arrows). Coronal diffusion weighted image (c), and ADC (d), showed characteristic restricted diffusion of associated soft-tissue components. Axial high-resolution non-contrast CT head in bone window (e) demonstrated permeative pattern of osseous infiltration of the left fronto-temporal calvarial bones (arrows). Axial PET image (f) confirmed hypermetabolic activity of the mass (arrow).
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F7
High-resolution contrast-enhanced CT neck showed diffuse osseous infiltration of the left frontal, and temporal calvarial bones, left sphenoid, and posterolateral orbital wall as well as the left zygomatic arch [Figure 7].