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FDG PET/CT detects benign neurofibromas presenting as nodal masses: Imaging hallmarks of a diagnostic "red herring".

Puranik AD, Purandare NC, Bal MM, Agrawal A, Shah S, Rangarajan V - Indian J Nucl Med (2015 Apr-Jun)

Bottom Line: Multi-modality positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-deoxy-glucose (FDG) depicts the enhancement pattern and metabolic intensity of lesions.Benign lesions with multiplicity, like neurofibromas often mimic similar appearing malignant neoplasms.We, report, a similar case where FDG PET/CT shows imaging hallmarks for diagnosing benign neurofibromas, in a patient with clinical presentation of lymphoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

ABSTRACT
Multi-modality positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-deoxy-glucose (FDG) depicts the enhancement pattern and metabolic intensity of lesions. Benign lesions with multiplicity, like neurofibromas often mimic similar appearing malignant neoplasms. We, report, a similar case where FDG PET/CT shows imaging hallmarks for diagnosing benign neurofibromas, in a patient with clinical presentation of lymphoma.

No MeSH data available.


Related in: MedlinePlus

MIP image (a) shows increased FDG uptake in neck, thorax and abdomen (arrows) – pattern suggestive of nodal involvement. Axial CECT (b and c – arrows) and fused PET/CT (d and e - arrows) images show FDG avid non-enhancing nodal masses in cervical and axillary regions. Also seen is a hypodense non-enhancing left breast mass (arrow head) with patchy FDG FDG uptake
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Figure 1: MIP image (a) shows increased FDG uptake in neck, thorax and abdomen (arrows) – pattern suggestive of nodal involvement. Axial CECT (b and c – arrows) and fused PET/CT (d and e - arrows) images show FDG avid non-enhancing nodal masses in cervical and axillary regions. Also seen is a hypodense non-enhancing left breast mass (arrow head) with patchy FDG FDG uptake

Mentions: A 33-year-old female presented with large right sided neck and axillary swellings. She was otherwise asymptomatic with no relevant family history. Biopsy at the primary care center was suggestive of dense lymphocytic infiltration. With a high suspicion of lymphoma, she was referred to our tertiary care centre for further management. Whole body 18F-FDG PET/CECT (Contrast enhanced CT) study was performed for staging. Maximum intensity projection (MIP) image showed multiple areas of increased tracer uptake in neck, thorax, and abdomen [Figure 1a, arrows]. Axial CT [Figure 1b and c] and fused PET/CT [Figure 1d and e] images showed bulky nonenhancing masses in right cervical level II, anterior mediastinal and left axillary regions. A discrete mass was also seen in left breast parenchyma [Figure 1c and e – arrowheads]. Multiple cutaneous, subcutaneous, and mesenteric lesions [Figure 2a-c] were seen on fused coronal [Figure 2a – arrow] and axial [Figure 2b and c – arrows] images. All these lesions showed low grade intensity of FDG uptake, with maximum standardised uptake values (max SUV) ranging from 2.1 to 3.2. CT showed well-defined, non-enhancing, low attenuation masses. Imaging features on PET and CT were not classical for lymphomatous involvement. Since, enhancement pattern and metabolic intensity were strongly suspicious for presence of benign masses, repeat biopsy was performed from cervical and axillary nodal masses. Biopsy core [Figure 3a - hematoxylin and eosin stain, ×100)] showed a pauci-cellular spindle cell tumor with myxoid stroma. On immunohistochemistry [Figure 3b], tumor cells were strongly positive for S100, weak positive for smooth muscle actin, (SMA) and negative for epithelial membrane antigen (EMA) and desmin. This confirmed the presence of a benign peripheral nerve sheath tumor, consistent with neurofibroma.


FDG PET/CT detects benign neurofibromas presenting as nodal masses: Imaging hallmarks of a diagnostic "red herring".

Puranik AD, Purandare NC, Bal MM, Agrawal A, Shah S, Rangarajan V - Indian J Nucl Med (2015 Apr-Jun)

MIP image (a) shows increased FDG uptake in neck, thorax and abdomen (arrows) – pattern suggestive of nodal involvement. Axial CECT (b and c – arrows) and fused PET/CT (d and e - arrows) images show FDG avid non-enhancing nodal masses in cervical and axillary regions. Also seen is a hypodense non-enhancing left breast mass (arrow head) with patchy FDG FDG uptake
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4379676&req=5

Figure 1: MIP image (a) shows increased FDG uptake in neck, thorax and abdomen (arrows) – pattern suggestive of nodal involvement. Axial CECT (b and c – arrows) and fused PET/CT (d and e - arrows) images show FDG avid non-enhancing nodal masses in cervical and axillary regions. Also seen is a hypodense non-enhancing left breast mass (arrow head) with patchy FDG FDG uptake
Mentions: A 33-year-old female presented with large right sided neck and axillary swellings. She was otherwise asymptomatic with no relevant family history. Biopsy at the primary care center was suggestive of dense lymphocytic infiltration. With a high suspicion of lymphoma, she was referred to our tertiary care centre for further management. Whole body 18F-FDG PET/CECT (Contrast enhanced CT) study was performed for staging. Maximum intensity projection (MIP) image showed multiple areas of increased tracer uptake in neck, thorax, and abdomen [Figure 1a, arrows]. Axial CT [Figure 1b and c] and fused PET/CT [Figure 1d and e] images showed bulky nonenhancing masses in right cervical level II, anterior mediastinal and left axillary regions. A discrete mass was also seen in left breast parenchyma [Figure 1c and e – arrowheads]. Multiple cutaneous, subcutaneous, and mesenteric lesions [Figure 2a-c] were seen on fused coronal [Figure 2a – arrow] and axial [Figure 2b and c – arrows] images. All these lesions showed low grade intensity of FDG uptake, with maximum standardised uptake values (max SUV) ranging from 2.1 to 3.2. CT showed well-defined, non-enhancing, low attenuation masses. Imaging features on PET and CT were not classical for lymphomatous involvement. Since, enhancement pattern and metabolic intensity were strongly suspicious for presence of benign masses, repeat biopsy was performed from cervical and axillary nodal masses. Biopsy core [Figure 3a - hematoxylin and eosin stain, ×100)] showed a pauci-cellular spindle cell tumor with myxoid stroma. On immunohistochemistry [Figure 3b], tumor cells were strongly positive for S100, weak positive for smooth muscle actin, (SMA) and negative for epithelial membrane antigen (EMA) and desmin. This confirmed the presence of a benign peripheral nerve sheath tumor, consistent with neurofibroma.

Bottom Line: Multi-modality positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-deoxy-glucose (FDG) depicts the enhancement pattern and metabolic intensity of lesions.Benign lesions with multiplicity, like neurofibromas often mimic similar appearing malignant neoplasms.We, report, a similar case where FDG PET/CT shows imaging hallmarks for diagnosing benign neurofibromas, in a patient with clinical presentation of lymphoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India.

ABSTRACT
Multi-modality positron emission tomography/computed tomography (PET/CT) with 18F-fluoro-deoxy-glucose (FDG) depicts the enhancement pattern and metabolic intensity of lesions. Benign lesions with multiplicity, like neurofibromas often mimic similar appearing malignant neoplasms. We, report, a similar case where FDG PET/CT shows imaging hallmarks for diagnosing benign neurofibromas, in a patient with clinical presentation of lymphoma.

No MeSH data available.


Related in: MedlinePlus