Rare ocular and skin lesions of Marginal Zone Lymphoma detected by 18F-FDG PET/CT

We report a case of a 75-year old man that came at hematologist’s attention for lymphoma evaluation due to axillary lymph node enlargement and fever. Thorax, abdomen and pelvis Contrast-Enhanced Computed Tomography (CECT) showed lymph nodes, spleen and liver lesions. Axillary lymph node biopsy was performed and the diagnosis of marginal zone lymphoma (MZL) at stage IV was postulated, then the patient was submitted to chemotherapy (CHT) following the R-CVP scheme. After the end of the eighth cycle of CHT he was submitted to a restaging CECT that showed lymph nodes size reduction in all the sites identified on the staging exam. Furthermore the liver lesions disappeared and spleen lesions size was reduced. A whole-body and head 18F-FDG PET/CT was also performed that showed 18F-FDG uptake lesions in right axillary lymph nodes, spleen and liver and the identification of two more extranodal sites, respectively in conjunctiva and skin. Then the necessity of additional CHT cycles and radiotherapy on extranodal sites was postulated. The patient declined the new therapies and unfortunately succumbed four months later. In our case whole body and head 18F-FDG-PET/CT, finding two new extranodal lymphomatous sites and confirming the persistence of the disease, refined and guided the management of the patient suggesting the necessity of additional CHT cycles and radiotherapy on extranodal sites. After histopathological confirmation, a systemic work-up by an oncologist should include whole body and head 18F-FDG-PET/CT to detect possible systemic involvement and guide specific following diagnostic exams.