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Charcoal-induced granuloma that mimicked a nodal metastasis on ultrasonography and FDG-PET/CT after neck dissection.

Choi JW, Moon WJ, Choi N, Roh HG, Kim MY, Kim NR, Moon SG, Chung HW, Lim SD, Yang JH - Korean J Radiol (2015)

Bottom Line: Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck.Charcoal remains stable without causing foreign body reactions during as hort period.However, foreign body reactions may develop if charcoal is left in situ for more than 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 143-729, Korea.

ABSTRACT
Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.

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US, PET/CT, chest CT and pathologic findings of charcoal-induced granuloma.Preoperative US (A) shows several hypoechoic nodules with well-defined margins (arrows) and one well-defined, isoechoic nodule (broken arrow) with internal high echoic dots in right level IV. These lymph nodes were localized using charcoal and revealed metastatic lymph nodes with perinodal infiltration. Follow-up US at 6 months (B) shows irregularly shaped, hyperechoic nodule measuring 9.8 mm with indistinct margin with adjacent sternocleidomastoid muscle and fat of posterior cervical space (arrows). On 2-year follow-up US for US-guided core biopsy (C), compared to previous US (B), echogenicity of nodule decreased, and posterior acoustic shadowing was prominent (arrows). Six-month, initial follow-up FDG-PET and PET/CT (D) shows hypermetabolic nodule (SUVmax = 4.0) at right level IV (arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography. Lesion is still hypermetablic (SUVmax = 4.3) (arrow) on 18-month follow-up FDG-PET and PET/CT (E). Precontrast chest CT (F) acquired at same day shows slightly hyperdense, oval-shaped nodule at lateral aspect of right internal jugular vein (arrow). Postcontrast CT (G) shows no definite enhancement of nodule (arrow). Gross specimen (H) shows black-pigmented soft tissue fragment. Microscopic image (H&E staining, × 300) (I) shows black pigments suggesting charcoal particles (asterisks) surrounded by multinucleared giant cells (arrows) and fibrosis (broken arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography
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Figure 1: US, PET/CT, chest CT and pathologic findings of charcoal-induced granuloma.Preoperative US (A) shows several hypoechoic nodules with well-defined margins (arrows) and one well-defined, isoechoic nodule (broken arrow) with internal high echoic dots in right level IV. These lymph nodes were localized using charcoal and revealed metastatic lymph nodes with perinodal infiltration. Follow-up US at 6 months (B) shows irregularly shaped, hyperechoic nodule measuring 9.8 mm with indistinct margin with adjacent sternocleidomastoid muscle and fat of posterior cervical space (arrows). On 2-year follow-up US for US-guided core biopsy (C), compared to previous US (B), echogenicity of nodule decreased, and posterior acoustic shadowing was prominent (arrows). Six-month, initial follow-up FDG-PET and PET/CT (D) shows hypermetabolic nodule (SUVmax = 4.0) at right level IV (arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography. Lesion is still hypermetablic (SUVmax = 4.3) (arrow) on 18-month follow-up FDG-PET and PET/CT (E). Precontrast chest CT (F) acquired at same day shows slightly hyperdense, oval-shaped nodule at lateral aspect of right internal jugular vein (arrow). Postcontrast CT (G) shows no definite enhancement of nodule (arrow). Gross specimen (H) shows black-pigmented soft tissue fragment. Microscopic image (H&E staining, × 300) (I) shows black pigments suggesting charcoal particles (asterisks) surrounded by multinucleared giant cells (arrows) and fibrosis (broken arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography

Mentions: A 47-year-old woman was referred to our department for US-guided biopsy due to a persistent hypermetabolic nodule in the right level IV nodal station. She was diagnosed with invasive ductal carcinoma of the right breast and cervical lymph node metastasis at the right level IV (TNM stage; T2N3M0). She had undergone breast-conserving surgery and excision of a metastatic lymph node (Fig. 1A) 3 years prior. Before excision of cervical lymph node metastasis, US-guided localization had been performed using charcoal. The surgical specimen of the cervical lymph node revealed metastasis with perinodal infiltration. After surgery, she received chemotherapy and radiotherapy (up to 50.4 Gy) for the right breast and the right lower cervical area.


Charcoal-induced granuloma that mimicked a nodal metastasis on ultrasonography and FDG-PET/CT after neck dissection.

Choi JW, Moon WJ, Choi N, Roh HG, Kim MY, Kim NR, Moon SG, Chung HW, Lim SD, Yang JH - Korean J Radiol (2015)

US, PET/CT, chest CT and pathologic findings of charcoal-induced granuloma.Preoperative US (A) shows several hypoechoic nodules with well-defined margins (arrows) and one well-defined, isoechoic nodule (broken arrow) with internal high echoic dots in right level IV. These lymph nodes were localized using charcoal and revealed metastatic lymph nodes with perinodal infiltration. Follow-up US at 6 months (B) shows irregularly shaped, hyperechoic nodule measuring 9.8 mm with indistinct margin with adjacent sternocleidomastoid muscle and fat of posterior cervical space (arrows). On 2-year follow-up US for US-guided core biopsy (C), compared to previous US (B), echogenicity of nodule decreased, and posterior acoustic shadowing was prominent (arrows). Six-month, initial follow-up FDG-PET and PET/CT (D) shows hypermetabolic nodule (SUVmax = 4.0) at right level IV (arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography. Lesion is still hypermetablic (SUVmax = 4.3) (arrow) on 18-month follow-up FDG-PET and PET/CT (E). Precontrast chest CT (F) acquired at same day shows slightly hyperdense, oval-shaped nodule at lateral aspect of right internal jugular vein (arrow). Postcontrast CT (G) shows no definite enhancement of nodule (arrow). Gross specimen (H) shows black-pigmented soft tissue fragment. Microscopic image (H&E staining, × 300) (I) shows black pigments suggesting charcoal particles (asterisks) surrounded by multinucleared giant cells (arrows) and fibrosis (broken arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296270&req=5

Figure 1: US, PET/CT, chest CT and pathologic findings of charcoal-induced granuloma.Preoperative US (A) shows several hypoechoic nodules with well-defined margins (arrows) and one well-defined, isoechoic nodule (broken arrow) with internal high echoic dots in right level IV. These lymph nodes were localized using charcoal and revealed metastatic lymph nodes with perinodal infiltration. Follow-up US at 6 months (B) shows irregularly shaped, hyperechoic nodule measuring 9.8 mm with indistinct margin with adjacent sternocleidomastoid muscle and fat of posterior cervical space (arrows). On 2-year follow-up US for US-guided core biopsy (C), compared to previous US (B), echogenicity of nodule decreased, and posterior acoustic shadowing was prominent (arrows). Six-month, initial follow-up FDG-PET and PET/CT (D) shows hypermetabolic nodule (SUVmax = 4.0) at right level IV (arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography. Lesion is still hypermetablic (SUVmax = 4.3) (arrow) on 18-month follow-up FDG-PET and PET/CT (E). Precontrast chest CT (F) acquired at same day shows slightly hyperdense, oval-shaped nodule at lateral aspect of right internal jugular vein (arrow). Postcontrast CT (G) shows no definite enhancement of nodule (arrow). Gross specimen (H) shows black-pigmented soft tissue fragment. Microscopic image (H&E staining, × 300) (I) shows black pigments suggesting charcoal particles (asterisks) surrounded by multinucleared giant cells (arrows) and fibrosis (broken arrow). FDG = fluorodeoxyglucose, PET = positron emission tomography, SUVmax = maximum standardized uptake value, US = ultrasonography
Mentions: A 47-year-old woman was referred to our department for US-guided biopsy due to a persistent hypermetabolic nodule in the right level IV nodal station. She was diagnosed with invasive ductal carcinoma of the right breast and cervical lymph node metastasis at the right level IV (TNM stage; T2N3M0). She had undergone breast-conserving surgery and excision of a metastatic lymph node (Fig. 1A) 3 years prior. Before excision of cervical lymph node metastasis, US-guided localization had been performed using charcoal. The surgical specimen of the cervical lymph node revealed metastasis with perinodal infiltration. After surgery, she received chemotherapy and radiotherapy (up to 50.4 Gy) for the right breast and the right lower cervical area.

Bottom Line: Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck.Charcoal remains stable without causing foreign body reactions during as hort period.However, foreign body reactions may develop if charcoal is left in situ for more than 6 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 143-729, Korea.

ABSTRACT
Charcoal can be used for preoperative localization of metastatic lymph nodes in the neck. Charcoal remains stable without causing foreign body reactions during as hort period. However, foreign body reactions may develop if charcoal is left in situ for more than 6 months. We reported a case of charcoal granuloma mimicking local recurrence on fluorodeoxyglucose-positron emission tomography/computed tomography and ultrasonography in a 47-year-old woman who had cervical lymph node dissection due to metastatic invasive ductal carcinoma of the breast.

Show MeSH
Related in: MedlinePlus