Synchronous diffuse large B-cell lymphoma and mantle cell lymphoma: support for low-threshold biopsies and genetic testing.

The differential intensity of FDG-avid lesions, along with acute and chronic symptoms and iron deficiency anemia caused by intestine involvement, was suspect for distinct disease entities, and consequently the axilla and colon lesions were biopsied. The intensity PET-CT projection showed multiple lesions with varying maximum standardized uptake values (SUVmax), indicating that these lesions reflect different disease entities (Figure 1(A,B)). These two lesions were biopsied and it has been assumed that these represent all other lesions with comparable FDG-avidity because taking more biopsies is not patient friendly, clinically inefficient and the chances of having a third synchronous lymphoma are negligibly small. The presented unique case demonstrated this individualized approach for both lymphoma subtypes and anatomical sites by adjuvant radiotherapy of the axillary PET avid lesions and the initiation of LR for the persistent MCL bowel lesions. [Extracted from the article]