Synchronous diffuse large B-cell lymphoma and squamous cell lung carcinoma.

Area of Science:

• Oncology
• Nuclear Medicine
• Thoracic Surgery

Background:

• Synchronous malignancies present diagnostic and staging challenges.
• 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is crucial for cancer staging but can be confounded by concurrent conditions.

Purpose of the Study:

• To report a rare case of synchronous diffuse large B-cell lymphoma and squamous cell lung carcinoma.
• To illustrate the diagnostic limitations of initial FDG-PET in complex oncological cases.
• To demonstrate the successful management strategy for synchronous thoracic malignancies.

Main Methods:

• Clinical presentation of a 68-year-old woman with a pulmonary nodule and lymphadenopathy.
• Diagnostic workup including physical examination, FDG-PET imaging, and biopsies.
• Sequential treatment approach, prioritizing lymphoma therapy before lung cancer management.
• Post-treatment FDG-PET for reassessment and surgical planning.

Main Results:

• Biopsies confirmed synchronous diffuse large B-cell lymphoma and squamous cell lung carcinoma.
• Initial FDG-PET showed uptake in both malignancies and lymph nodes, complicating staging.
• Post-lymphoma treatment FDG-PET revealed resolution of lymphoma-related uptake, allowing accurate lung cancer staging.
• Successful radical surgery for lung cancer was performed.

Conclusions:

• This case underscores the potential limitations of single-modality imaging like FDG-PET in diagnosing and staging synchronous malignancies.
• A multidisciplinary approach and sequential diagnostic/therapeutic strategies are vital for managing complex cases of concurrent cancers.
• Accurate staging is achievable even in challenging scenarios with careful interpretation of serial imaging findings.