Gallbladder Involvement of Diffuse Large B-Cell Lymphoma with 18F-FDG PET/CT

18F-Fluoro-2-deoxy-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) is widely used in staging, restaging, and evaluation of treatment response in patients with lymphoma. In this case report, a 59-year-old woman diagnosed with diffuse large B-cell lymphoma (DLBCL) with gallbladder involvement is presented. Immunohistochemical analysis showed strongly positive CD79a, bcl-6, MUM1, bcl-2, and CD43; weakly positive CD20 and CD5 staining; negative c-myc; and Ki-67 of 85%. Interim 18F-FDG PET/CT showed involvement of multiple lymph nodes with high radiopharmaceutical uptake in supra- and infradiaphragmatic lymphatic stations (Figure 1). On the other hand, increased 18F-FDG uptake was observed in newly developed metastatic nodes in addition to previous lesions in the supra/infradiaphragmatic regions on posttreatment PET/CT. Additionally, focal 18F-FDG uptake (dashed arrows) in the upper outer quadrant of the right breast and unexpected gallbladder (GB) wall involvement (arrows) were observed (Figure 2).

Figure 1

Involvement of multiple lymph nodes with high radiopharmaceutical uptake in supra- and infradiaphragmatic lymphatic stations.

CT: Computed tomography, PET: positron emission tomography, F: fusion, MIP: maximum intensity projection.

Figure 2

Increased 18F-FDG uptake was observed in newly developed metastatic nodes in addition to previous lesions in the supra/infradiaphragmatic regions on posttreatment PET/CT. Additionally, focal 18F-FDG uptake (dashed arrows) in the upper outer quadrant of the right breast and unexpected gallbladder (GB) wall involvement (arrows) were observed.

CT: Computed tomography, PET: positron emission tomography, F: fusion, MIP: maximum intensity projection.

18F-FDG PET/CT is a diagnostic method for detecting metastatic lesions in GB [1,2,3].Although the involvement of the breasts and thyroid in non-Hodgkin’s lymphoma is frequently reported, involvement of the GB is extremely rare [4,5,6]. Al-Katib et al. [7] detected extranodal involvement of the GB in an 83-year-old male with intravascular large B-cell lymphoma. Bai et al. [8] reported increased 18F-FDG uptake in the GB without luminal pathology in a 15-year-old girl with Hodgkin’s disease.In our case, 18F-FDG PET/CT imaging revealed DLBCL-related involvement in the GB. PET/CT is a useful tool for demonstrating unexpected organ involvements, such as in the GB.