Abstract Details

Title Diagnostic Utility of 18FDG-PET in Neurolymphomatosis Presenting as Atypical Facial Pain

Topic Neuro-oncology

Presentation(s) P06 - (-)

Poster/Presentation
Number 146

Objective

Background BACKGROUND: NL, or lymphomatous infiltration of the nervous system, is a rare primary or secondary manifestation of hematological malignancy. Establishing the diagnosis can be difficult using conventional imaging modalities. Cerebral spinal fluid (CSF) and bone marrow analysis do not increase the diagnostic yield. Nerve biopsy, although both sensitive and specific, may result in permanent nerve damage. During the last decade, FDG PET imaging has been used to diagnose, stage, and monitor treatment in lymphoma. Recent literature supports a diagnostic role for FDG-PET in the evaluation of patients with suspected NL.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 70-year-old woman undergoing treatment for aggressive B-cell non-Hodgkin lymphoma presented with episodic left-sided facial pain. The lymphoma initially presented as a left neck mass and also involved the submandibular, cervical, axillary, mesenteric and inguinal nodes. Recent FDG PET imaging had shown near complete resolution of the malignancy following chemotherapy. The facial pain was periorbital and extended along the zygomatic bone. She denied photophobia, phonophobia, nausea, vomiting or associated autonomic features. Initial neurologic examination was normal. Magnetic resonance imaging (MRI) of the face, orbit and neck with contrast was negative. A week after presentation, she developed hypesthesia in a V3/V2 distribution. Repeat MRI was again non-diagnostic. CSF analysis was negative. FDG PET-CT scan showed increased FDG uptake along the left V3 branch of the trigeminal nerve and in the left parotid gland. An ultrasound guided biopsy of the left parotid lesion confirmed recurrent lymphoma.

Conclusions CONCLUSIONS: Cranial neuropathy is a rare presentation of NL and establishing the diagnosis can be challenging. This case illustrates the potential diagnostic utility for FDG PET in the evaluation of patients with suspected NL especially if MRI is negative.

Authors/Disclosures
Michel Toledano, MD (Mayo Clinic) PRESENTER	Dr. Toledano has nothing to disclose.
	No disclosure on file
	No disclosure on file
Ivan Garza, MD, FAAN (Mayo Clinic)	No disclosure on file
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Bruce A. Cree, MD, PhD, MAS, FAAN (UCSF, Multiple Sclerosis Center)	The institution of Dr. Cree has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Cree has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neuron23. Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Pharma. Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal/Sandoz. Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunic AG. The institution of Dr. Cree has received research support from Genentech. The institution of Dr. Cree has received research support from Kyverna. Dr. Cree has received publishing royalties from a publication relating to health care.

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