Reactive Tonsillar Enlargement Showing Strong 18F-Fdg Uptake During the Follow-Up of Follicular Lymphoma

• Published in: Head & neck pathology (Totowa, N.J.) Vol. 7; no. 3; pp. 258 - 262
• Main Authors: Feio, Patricia do Socorro Queiroz, Gomes, Camilla Borges Ferreira, Nogueira, Alexandre Simões, Almeida, Luciana Yamamoto, Vassallo, José, Soares, Fernando Augusto, Almeida, Oslei Paes, León, Jorge Esquiche
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.09.2013
• Subjects: Adult; Case Report; Dentistry; Diagnostic Errors; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Hyperplasia - diagnostic imaging; Lymphoma, Follicular - diagnostic imaging; Male; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - diagnostic imaging; Oral and Maxillofacial Surgery; Otorhinolaryngology; Pathology; Positron-Emission Tomography; Radiopharmaceuticals; Tonsillar Neoplasms - diagnostic imaging; Chemotherapy; Tonsillar enlargement Reactive follicular Hyperplasia; F-FDG-PET; Lymphoma
• ISSN: 1936-055X; 1936-0568
• DOI: 10.1007/s12105-012-0400-5

The 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a standard procedure for the diagnosis, staging, and restaging in lymphoma patients. However, a relative high rate of false-positive results has been reported. We report a case of a 40-year-old man with a previous history of a nodal follicular lymphoma, stage IVA, treated with R-CHOP, which showed strong 18 F-FDG uptake in the Waldeyer’s tonsillar ring during his follow-up, being considered highly suspicious of relapsed lymphoma. A surgical removal of the palatine tonsils and adenoids was performed, which showed reactive follicular hyperplasia. Furthermore, bone marrow biopsy revealed absence of neoplasia. The patient is still in follow-up with no signs of recurrent lymphoma. This case illustrates that, despite the high sensitivity for the detection of recurrent lymphoma, 18 F-FDG uptake should be interpreted with great caution and confirmatory studies should be performed before any therapy.