The clinical value of imaging in primary cutaneous lymphomas: Role of high resolution ultrasound and PET-CT

Abstract

Background: Primary cutaneous lymphoma is a rare extranodal non-Hodgkin’s lymphoma confined to the skin. The data on the imaging findings of primary cutaneous lymphomas are largely lacking and the current diagnosis is based on clinical and histopathological examination. With the advances in dermatological ultrasound and molecular imaging, newer perspectives in the evaluation of cutaneous lymphomas are available. Objective: To review and describe the imaging findings in patient’s with the diagnosis of primary cutaneous lymphoma. Methods: A multicentric, retrospective observational study was undertaken in four countries to review the high resolution ultrasonography (HRUS) and fluorine 18-fludeoxyglucose positron emission tomography-computed tomography (PET-CT) imaging findings. Results: We had 41 patients, Female:Male 1:4.1; mean age, 57 years; range, 13–94 years. High resolution ultrasonography of the primary cutaneous lesions revealed thickening of the dermis in all the cases and the lesions were hypoechoic without any calcifications or central necrosis. The sonographic appearances of the lesions were categorised into focal infiltrative, nodular, pseudonodular, and diffusely infiltrative patterns. Nodular and pseudonodular lesions were predominant in B cell lymphomas, while diffusely infiltrative lesions were more common in T-cell lymphomas. On colour Doppler imaging, the lesions were hypervascular. Whole body 18F-fludeoxyglucose PET–CT imaging of the patients revealed increased uptake of the metabolite in the lesions. Conclusion: Sonographic patterns based on high resolution ultrasonography provide early clues to the non-invasive diagnosis of primary cutaneous lymphomas and PET-CT is the recommended modality of imaging for staging and follow-up. Advances in knowledge: High resolution ultrasound with colour Doppler and PET-CT imaging are complimentary to the clinical diagnosis of primary cutaneous lymphomas.

Morphologic Features of Cutaneous T-Cell Lymphomas Using Dermoscopy and High Frequency Ultrasound

“…High-frequency ultrasonography (HFUS) represents another non-invasive method used to assess skin neoplasms. Preliminary results support its applicability in the diagnosis of MF [ 11 , 12 ].…”

“…Early reports of ultrasound in CTCL date back to the late 1990s. However, until recently its clinical utility was limited by low-frequency transducers lacking adequate resolution [ 8 , 11 , 12 , 18 , 19 ].…”

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound

“…Skin lymphoma, angiosarcoma, Kaposi sarcoma, adnexal carcinoma and other non-melanoma skin cancer (NMSC) can also be assessed using US [35][36][37]. Cutaneous lymphoma may appear either as a nodular or diffuse mass.…”

“…The diffuse form appears as a hyperechoic, poorly defined area with increased thickness of the subepithelial layers. The thickness or degree of infiltration of cutaneous lymphoma can also be assessed by US [37]. Moreover, the changes in skin infiltration following therapy can be evaluated by B-mode US examination and elastography.…”

Role of Ultrasound in a Rare Case of Primary Lymphoma of the Cranial Vault

“…The differential diagnosis in our case was limited to lesions that result in infiltration of the bone, such as anaplastic meningiomas, osteomyelitis, sarcomas, metastases, and myeloma. The ultrasound study therefore has been focused on the characteristics of the intralesional vascularization which, in the case of lymphomas, can provide valuable elements for the differential diagnosis [18]. The duplex Doppler did not provide relevant elements for the differential diagnosis since the sampling of the intralesional arterial vessels did not show high systolic peak velocities, present instead in many other malignant neoplasms.…”