CASE REPORT 
Annals of Nuclear Medicine Vol. 14, No. 5, 387-389, 2000 

A case of malignant lymphoma of the hand 

Hitoya OHTA,* Tsuneshi NAKANO,* Noriyuki KOJIMA.* Takashi ISHIGAKI,* Satoshi NISHIKAWA,* Giro TODO* and Masavuki SHINTAKU** 

Departments of *Radiology and **Pathology, Osaka Red Cross Hospital
 
Malignant lymphoma is rarely seen in the hand. We present a case of malignant lymphoma of the hand with Ga-67 citrate and MR images, and discuss the usefulness of Ga-67 citrate scintigraphy for diagnosing this condition.

 Key words: malignant lymphoma, hand, soft tissue,Ga-67 citrate, MRI 

INTRODUCTION 
MALIGNANT LYMPHOMA (ML) is rarely seen in hands. And there is not an extensive literature on ML presenting in soft tissue.1,2 we present a case of ML of the hand with Ga-67 citrate and MR images, and discuss the usefulness of Ga-67 citrate scintigraphy for diagnosing this condition. 

CASE REPORT 
A 76-year-old male was referred to our hospital because of a swelling of the right hand (Fig. 1). Ten months previously he noticed swelling of the right hand, but neglected it because he remained asymptomatic. The swelling slowly progressed. Routine hematological and blood chemistry findings were not remarkable. Soluble interleukin-2 receptor was I 150 U/ml (normal range 145-519).
 MR images showed a tumor on the back of the hand. The tumor showed iso-intensity on Tl-weighted images, high intensity on T2-weighted images, and homogeneous enhancement. Flow void was recognized in the tumor (Fig. 2 upper: T1-weighted, middle: T2-weighted, Iower: enhanced Tl-weighted).
 Ga-67 citrate scintigram showed intense tracer uptake in the tumor suggestive of ML (Fig. 3), and biopsy of the tumor was performed. Histopathologic examination showed ML (T-cell, pleomorphic small/medium sized).
 
 Received June 8. 2000, revision accepted July 24, 2000
 For reprint contact: Hitoya Ohta, M.D., Department of Radiology. Osaka Red Cross Hospital, Osaka 543-8555, JAPAN.
 
The dermis was intact, and ML cells occupied subcutaneous tissue (Fig. 4A and B). Ga-67 scintigram showed no other abnormal tracer uptake, and CT images of the thorax, abdomen and pelvis also showed no other lesion. Radiation therapy (2 Gy x 24, Total 48 Gy) was performed, and the tumor decreased in size. Follow-up Ga-67 citrate scintigram showed greatly decreased tracer uptake in the tumor (Fig. 5).

 DISCUSSION 
ML localized in subcutaneous tissue but not in dermis is very rare. In the present case the back of the hand seemed to be normal, and it was difficult to confirm ML by physical findings, but Ga-67 citrate scintigram showed intense tracer uptake in the tumor suggestive of ML, and biopsy was performed to confirm the scintigraphic finding. Ga-67 citrate scintigraphy provided useful information for diagnosing this condition.
 Histopathological findings showed that the lesion was predominantly localized in subcutaneous tissue but not in dermis. In many reports. ML originating in subcutaneous tissue has been classified as cutaneous ML, whereas others only of dermis origin have been classified as cutaneous ML. There seems no consistent classification of ML originating in subcutaneous tissue.1-5 we considered that this case was ML derived from soft tissue because subcutaneous tissue anatomically belongs to soft tissue. ML presenting in soft tissue is extremely rare,1,2
 In conclusion, we report a rare case of ML of the hand and showed the usefulness of Ga-67 citrate scintigraphy, although the usefulness of Ga-67 citrate scintigraphy for ML is already well known.6.7 

ACKNOWLEDGMENTS 
We gratefully thank Miss. Chizuko Mori, Mr. Norimasa Takayanagi and Mr. Hiromitsu Fukuda for their valuable assistance 

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