{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:23:17Z","timestamp":1789042997071,"version":"build-2803163510"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Hematopathol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>18-Fluorodeoxyglucose positron emission tomography\/computed tomography (FDG PET\/CT) scans have largely replaced bone marrow biopsy in the staging workup for diffuse large B-cell lymphoma (DLBCL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Methods<\/jats:title>\n                    <jats:p>Here, we highlight a pitfall of FDG PET\/CT for assessing bone marrow involvement, detailing the clinical course of a patient diagnosed with otherwise limited-stage DLBCL who exhibited diffuse bone marrow FDG uptake, felt to be compatible with extensive lymphomatous infiltration. In accordance with current National Comprehensive Cancer Network guidelines, this finding circumvented the need for a formal staging bone marrow biopsy procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Subsequent clinical developments revealed extensive bone marrow involvement by a second, unexpected malignancy (multiple myeloma), casting doubt on the assumption that the initial diffuse marrow uptake was attributable to DLBCL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The presented case emphasizes the challenges of interpreting diffuse FDG uptake within the bone marrow compartment and highlights the inherent contribution of histomorphology for the accurate diagnosis and classification of hematolymphoid neoplasms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12308-025-00667-1","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T05:53:17Z","timestamp":1762235597000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Staging FDG PET\/CT prediction of bone marrow involvement by diffuse large B-cell lymphoma leading to delayed recognition of multiple myeloma"],"prefix":"10.1007","volume":"18","author":[{"given":"Amanda C.","family":"Gibbs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prem P.","family":"Batchala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea E.","family":"Gottlieb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan O.","family":"Balle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ifeyinwa E.","family":"Obiorah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laahn H.","family":"Foster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily C.","family":"Ayers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey W.","family":"Craig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"issue":"9","key":"667_CR1","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1056\/NEJMra2027612","volume":"384","author":"LH Sehn","year":"2021","unstructured":"Sehn LH, Salles G (2021) Diffuse large B-cell lymphoma. N Engl J Med 384(9):842\u2013858. https:\/\/doi.org\/10.1056\/NEJMra2027612","journal-title":"N Engl J Med"},{"issue":"6","key":"667_CR2","first-page":"1023","volume":"61","author":"SA Rosenberg","year":"1977","unstructured":"Rosenberg SA (1977) Validity of the Ann Arbor staging classification for the non-Hodgkin\u2019s lymphomas. Cancer Treat Rep 61(6):1023\u20131027","journal-title":"Cancer Treat Rep"},{"issue":"6","key":"667_CR3","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1111\/j.1600-0609.2006.00644.x","volume":"76","author":"J Campbell","year":"2006","unstructured":"Campbell J, Seymour JF, Matthews J, Wolf M, Stone J, Juneja S (2006) The prognostic impact of bone marrow involvement in patients with diffuse large cell lymphoma varies according to the degree of infiltration and presence of discordant marrow involvement. Eur J Haematol 76(6):473\u2013480. https:\/\/doi.org\/10.1111\/j.1600-0609.2006.00644.x","journal-title":"Eur J Haematol"},{"issue":"11","key":"667_CR4","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1200\/JCO.1989.7.11.1630","volume":"7","author":"TA Lister","year":"1989","unstructured":"Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC et al (1989) Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin\u2019s disease: Cotswolds meeting. J Clin Oncol 7(11):1630\u20131636. https:\/\/doi.org\/10.1200\/JCO.1989.7.11.1630","journal-title":"J Clin Oncol"},{"issue":"11","key":"667_CR5","doi-asserted-by":"publisher","first-page":"1452","DOI":"10.1200\/JCO.2010.33.3419","volume":"29","author":"LH Sehn","year":"2011","unstructured":"Sehn LH, Scott DW, Chhanabhai M, Berry B, Ruskova A, Berkahn L et al (2011) Impact of concordant and discordant bone marrow involvement on outcome in diffuse large B-cell lymphoma treated with R-CHOP. J Clin Oncol 29(11):1452\u20131457. https:\/\/doi.org\/10.1200\/JCO.2010.33.3419","journal-title":"J Clin Oncol"},{"issue":"4","key":"667_CR6","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1182\/blood-2007-01-070300","volume":"110","author":"R Chung","year":"2007","unstructured":"Chung R, Lai R, Wei P, Lee J, Hanson J, Belch AR et al (2007) Concordant but not discordant bone marrow involvement in diffuse large B-cell lymphoma predicts a poor clinical outcome independent of the International Prognostic Index. Blood 110(4):1278\u20131282. https:\/\/doi.org\/10.1182\/blood-2007-01-070300","journal-title":"Blood"},{"issue":"2","key":"667_CR7","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.cpet.2023.12.014","volume":"19","author":"AS Parihar","year":"2024","unstructured":"Parihar AS, Pant N, Subramaniam RM (2024) Quarter-century PET\/CT transformation of oncology: lymphoma. PET Clin 19(2):281\u2013290. https:\/\/doi.org\/10.1016\/j.cpet.2023.12.014","journal-title":"PET Clin"},{"issue":"3","key":"667_CR8","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s00259-013-2623-4","volume":"41","author":"HJ Adams","year":"2014","unstructured":"Adams HJ, Kwee TC, de Keizer B, Fijnheer R, de Klerk JM, Nievelstein RA (2014) FDG PET\/CT for the detection of bone marrow involvement in diffuse large B-cell lymphoma: systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 41(3):565\u2013574. https:\/\/doi.org\/10.1007\/s00259-013-2623-4","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"27","key":"667_CR9","doi-asserted-by":"publisher","first-page":"3059","DOI":"10.1200\/JCO.2013.54.8800","volume":"32","author":"BD Cheson","year":"2014","unstructured":"Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E et al (2014) Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 32(27):3059\u20133068. https:\/\/doi.org\/10.1200\/JCO.2013.54.8800","journal-title":"J Clin Oncol"},{"issue":"14","key":"667_CR10","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1056\/NEJM199309303291402","volume":"329","author":"International Non-Hodgkin's Lymphoma Prognostic Factors Project","year":"1993","unstructured":"International Non-Hodgkin\u2019s Lymphoma Prognostic Factors Project (1993) A predictive model for aggressive non-Hodgkin\u2019s lymphoma. N Engl J Med 329(14):987\u2013994. https:\/\/doi.org\/10.1056\/NEJM199309303291402","journal-title":"N Engl J Med"},{"issue":"4","key":"667_CR11","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1056\/NEJMoa2115304","volume":"386","author":"H Tilly","year":"2022","unstructured":"Tilly H, Morschhauser F, Sehn LH, Friedberg JW, Trn\u011bn\u00fd M, Sharman JP et al (2022) Polatuzumab vedotin in previously untreated diffuse large B-cell lymphoma. N Engl J Med 386(4):351\u2013363. https:\/\/doi.org\/10.1056\/NEJMoa2115304","journal-title":"N Engl J Med"},{"key":"667_CR12","unstructured":"NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for B-Cell Lymphomas V.3.2024. \u00a9 National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed October 2, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org"},{"issue":"2","key":"667_CR13","doi-asserted-by":"publisher","DOI":"10.3390\/app12020540","volume":"12","author":"J Almaimani","year":"2022","unstructured":"Almaimani J, Tsoumpas C, Feltbower R, Polycarpou I (2022) FDG PET\/CT versus bone marrow biopsy for diagnosis of bone marrow involvement in non-Hodgkin lymphoma: a systematic review. Appl Sci 12(2):540. https:\/\/doi.org\/10.3390\/app12020540","journal-title":"Appl Sci"},{"issue":"25","key":"667_CR14","doi-asserted-by":"publisher","first-page":"2911","DOI":"10.1200\/JCO.2017.72.2975","volume":"35","author":"P Moreau","year":"2017","unstructured":"Moreau P, Attal M, Caillot D, Macro M, Karlin L, Garderet L et al (2017) Prospective evaluation of magnetic resonance imaging and [18f]fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM\/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol 35(25):2911\u20132918. https:\/\/doi.org\/10.1200\/JCO.2017.72.2975","journal-title":"J Clin Oncol"},{"issue":"6","key":"667_CR15","doi-asserted-by":"publisher","first-page":"658","DOI":"10.3390\/diagnostics14060658","volume":"14","author":"F Martin-Moro","year":"2024","unstructured":"Martin-Moro F, Lopez-Jimenez J, Garcia-Marco JA, Garcia-Vela JA (2024) Comparative review of the current and future strategies to evaluate bone marrow infiltration at diffuse large B-cell lymphoma diagnosis. Diagnostics (Basel) 14(6):658. https:\/\/doi.org\/10.3390\/diagnostics14060658","journal-title":"Diagnostics (Basel)"},{"issue":"6","key":"667_CR16","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.blre.2015.06.003","volume":"29","author":"HJ Adams","year":"2015","unstructured":"Adams HJ, Nievelstein RA, Kwee TC (2015) Opportunities and limitations of bone marrow biopsy and bone marrow FDG-PET in lymphoma. Blood Rev 29(6):417\u2013425. https:\/\/doi.org\/10.1016\/j.blre.2015.06.003","journal-title":"Blood Rev"},{"issue":"7","key":"667_CR17","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.7150\/jca.23714","volume":"9","author":"Y Chen","year":"2018","unstructured":"Chen Y, Zhou M, Liu J, Huang G (2018) Prognostic value of bone marrow FDG uptake pattern of PET\/CT in newly diagnosed diffuse large B-cell lymphoma. J Cancer 9(7):1231\u20131238. https:\/\/doi.org\/10.7150\/jca.23714","journal-title":"J Cancer"},{"issue":"4","key":"667_CR18","doi-asserted-by":"publisher","first-page":"e206","DOI":"10.1016\/S1470-2045(17)30189-4","volume":"18","author":"M Cavo","year":"2017","unstructured":"Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S et al (2017) Role of 18F-FDG PET\/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 18(4):e206\u2013e217. https:\/\/doi.org\/10.1016\/S1470-2045(17)30189-4","journal-title":"Lancet Oncol"},{"issue":"6","key":"667_CR19","doi-asserted-by":"publisher","first-page":"e300","DOI":"10.1097\/RLU.0000000000000773","volume":"40","author":"C Sachpekidis","year":"2015","unstructured":"Sachpekidis C, Mai EK, Goldschmidt H, Hillengass J, Hose D, Pan L et al (2015) (18)F-fdg dynamic PET\/CT in patients with multiple myeloma: patterns of tracer uptake and correlation with bone marrow plasma cell infiltration rate. Clin Nucl Med 40(6):e300-307. https:\/\/doi.org\/10.1097\/RLU.0000000000000773","journal-title":"Clin Nucl Med"},{"issue":"5","key":"667_CR20","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1007\/s00259-020-05078-1","volume":"48","author":"A Paschali","year":"2021","unstructured":"Paschali A, Panagiotidis E, Triantafyllou T, Palaska V, Tsirou K, Verrou E et al (2021) A proposed index of diffuse bone marrow [18F]-FDG uptake and PET skeletal patterns correlate with myeloma prognostic markers, plasma cell morphology, and response to therapy. Eur J Nucl Med Mol Imaging 48(5):1487\u20131497. https:\/\/doi.org\/10.1007\/s00259-020-05078-1","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"1","key":"667_CR21","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3816\/clm.2004.n.012","volume":"5","author":"RL Elstrom","year":"2004","unstructured":"Elstrom RL, Tsai DE, Vergilio JA, Downs LH, Alavi A, Schuster SJ (2004) Enhanced marrow [18F]fluorodeoxyglucose uptake related to myeloid hyperplasia in Hodgkin\u2019s lymphoma can simulate lymphoma involvement in marrow. Clin Lymphoma 5(1):62\u201364. https:\/\/doi.org\/10.3816\/clm.2004.n.012","journal-title":"Clin Lymphoma"},{"issue":"6","key":"667_CR22","doi-asserted-by":"publisher","first-page":"364","DOI":"10.3322\/caac.21156","volume":"62","author":"O Akin","year":"2012","unstructured":"Akin O, Brennan SB, Dershaw DD, Ginsberg MS, Gollub MJ, Sch\u00f6der H et al (2012) Advances in oncologic imaging: update on 5 common cancers. CA Cancer J Clin 62(6):364\u2013393. https:\/\/doi.org\/10.3322\/caac.21156","journal-title":"CA Cancer J Clin"},{"key":"667_CR23","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1301979","volume":"14","author":"R Alyamany","year":"2024","unstructured":"Alyamany R, El Fakih R, Alnughmush A, Albabtain A, Kharfan-Dabaja MA, Aljurf M (2024) A comprehensive review of the role of bone marrow biopsy and PET-CT in the evaluation of bone marrow involvement in adults newly diagnosed with DLBCL. Front Oncol 14:1301979. https:\/\/doi.org\/10.3389\/fonc.2024.1301979","journal-title":"Front Oncol"}],"container-title":["Journal of Hematopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12308-025-00667-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12308-025-00667-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12308-025-00667-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T18:04:15Z","timestamp":1762279455000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12308-025-00667-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,4]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["667"],"URL":"https:\/\/doi.org\/10.1007\/s12308-025-00667-1","relation":{},"ISSN":["1868-9256","1865-5785"],"issn-type":[{"value":"1868-9256","type":"print"},{"value":"1865-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,4]]},"assertion":[{"value":"14 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for formal Institutional Review Board approval was waived for this single-patient, retrospective study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was provided by the patient for both participation in the study and for publication of pertinent radiographic and histologic images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent\/consent for publication"}},{"value":"L.H.F. discloses industry sponsored studies with Janssen; advisory board honoraria from Bristol Myers Squibb, Janssen, Pfizer. E.C.A. discloses industry sponsored studies with ADC Therapeutics, Loxo Lilly, Abbvie, Regeneron, and Incyte; advisory board honoraria from ADC Therapeutics. J.W.C. discloses consultancy and expert testimony for Bayer; consultancy for AstraZeneca; honoraria from BeOne Medicines Ltd. (formerly BeiGene).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"49"}}