Epstein-Barr Virus–Positive Mucocutaneous Ulcer Mimicking Rectal Carcinoma at 18F-FDG PET/CT

Abstract

We report focally intense F-FDG PET/CT rectal activity (SUVmax = 25) with a horseshoe distribution in an 81-year-old man with B-cell chronic lymphocytic leukemia and suspected Richter transformation. While imaging findings were typical for rectal adenocarcinoma, histology revealed Epstein-Barr virus-positive mucocutaneous ulcer.

Two Cases of Epstein-Barr Virus–Positive Mucocutaneous Ulcer Mimicking Head and Neck Cancers in 18F-FDG PET/CT

“…EBVMCU also has a self-limited disease course and favorable prognosis even without chemotherapy after removing immunosuppressants 5,6 . Image findings of EBVMCU are not well described but can show ulcer and high FDG uptake on the surface of the skin or mucosal tissue, mimicking those of epithelial malignancies on the site 7,8 . Because the local histopathology of EBVMCU sometimes resembles other lymphoproliferative diseases, radiologists can assess the possibility of this disease by examining the whole body and noting the absence of aggressive disease in other sites, which can help avoid the need for intense chemotherapy.…”