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Gao C, Wang H, Liu H. Intramuscular Hemangioma of the Triceps Brachii Muscle: A Case Report. Int Med Case Rep J 2024; 17:31-34. [PMID: 38249659 PMCID: PMC10800111 DOI: 10.2147/imcrj.s441846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Intramuscular hemangioma (IMH) is a rare type of benign tumor that represents less than 1% of all hemangiomas. Chronic pain and a palpable mass are the most common symptoms. Due to the atypical clinical characteristics of the disease, accurate diagnosis is difficult. Misdiagnosis of IMH as malignancy can occur due to similarities in imaging features between IMH and malignancy. To diagnose IMH accurately, multiple imaging modalities, including X-ray, MRI, CT, and 18F-FDG PET/CT, can be used. However, the final diagnosis of IMH is confirmed through histopathological examination. Case This case reports a 16-year-old girl diagnosed with IMH in the triceps brachii muscle. Seek medical attention due to pain and discomfort in the left shoulder. Initial imaging with contrast-enhanced MRI and CT suggested synovial sarcomata. The moderate uptake of FDG on positron emission tomography/computed tomography (PET/CT) also raised suspicions of malignancy. The pathological findings revealed an intramuscular hemangioma with thrombosis and thrombus organization. Conclusion The accurate diagnosis of IMH can be challenging due to the absence of distinct clinical symptoms and imaging findings. When evaluating periarticular intramuscular lesions, IMH should be considered if the MRI shows mixed signals with heterogeneous enhancement. Despite the moderate uptake of FDG seen in some IMH cases, it should not automatically rule out the possibility of IMH. Hence, a combination of imaging modalities and histopathological examination is crucial in ensuring a correct diagnosis of IMH.
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Affiliation(s)
- Cailiang Gao
- Department of Nuclear Medicine, Three Gorges Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Hu Wang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Huiting Liu
- Department of Nuclear Medicine, Three Gorges Hospital, Chongqing University, Chongqing, People’s Republic of China
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Joseph AK, Guerin JB, Eckel LJ, Dalvin LA, Keating GF, Liebo GB, Benson JC, Brinjikji W, Laack NN, Silvera VM. Imaging Findings of Pediatric Orbital Masses and Tumor Mimics. Radiographics 2022; 42:880-897. [PMID: 35245105 DOI: 10.1148/rg.210116] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric orbital masses are not common but encompass a wide spectrum of benign and malignant entities that range from developmental anomalies to primary and secondary orbital malignancies and metastatic disease. Certain orbital tumors are unique to pediatric patients, such as retinoblastoma and neuroblastoma. Clinical symptoms and signs are often insufficient to differentiate between orbital lesions, and imaging is essential for narrowing the diagnostic considerations and determining the most appropriate management strategy. MRI is the primary imaging modality for evaluating orbital masses in children, with US and CT playing complementary roles. The authors review a spectrum of masses and tumor mimics that affect the pediatric globe and orbit. The shared and differentiating characteristics of pediatric orbital lesions are reviewed. Emphasis is placed on utilizing an orbital compartment-based approach to narrow the differential diagnosis. By using this organizational scheme, the authors describe intraocular processes (retinoblastoma, persistent fetal vasculature, and Coats disease), intraconal lesions (lymphatic malformation, schwannoma, optic nerve sheath meningioma, and optic pathway glioma), extraconal lesions (infantile hemangioma, rhabdomyosarcoma, idiopathic orbital inflammation, lymphoma, venous varix, plexiform neurofibroma, and pleomorphic adenoma of the lacrimal gland), and lesions involving the bony orbit (dermoid cyst, metastatic neuroblastoma, and Langerhans cell histiocytosis). The authors describe the basic management of each entity. Orbital infections and traumatic lesions are beyond the scope of this article. ©RSNA, 2022.
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Affiliation(s)
- Annie K Joseph
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Julie B Guerin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Laurence J Eckel
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lauren A Dalvin
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Gesina F Keating
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Greta B Liebo
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - John C Benson
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Waleed Brinjikji
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Nadia N Laack
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - V Michelle Silvera
- From the Departments of Radiology (A.K.J., J.B.G., L.J.E., G.B.L., J.C.B., W.B., V.M.S.), Ophthalmology (L.A.D.), Neurology (G.F.K.), Neurosurgery (W.B.), and Radiation Oncology (N.N.L.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Thilak R, Sivanesan A, Munuswamy H, Toi PC. A Giant Right Atrial Hemangioma- Case Report. Cureus 2022; 14:e24622. [PMID: 35664397 PMCID: PMC9150831 DOI: 10.7759/cureus.24622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/05/2022] Open
Abstract
A primary cardiac tumor is sporadic. Most cardiac tumors are benign, with cardiac myxoma being the most common tumor. The incidence of cardiac hemangioma is extremely low. We report a 55-year-old female patient admitted for chest pain and breathlessness and, on evaluation by Echocardiography and Computed tomography, was diagnosed with a right atrial mass. The patient was taken up for surgery. The excised right atrial mass was confirmed as atrial hemangioma by postoperative histopathology. Cardiac hemangioma should be suspected when imaging shows a homogenous mass with vascularity. We present this case as the tumor is sporadic and illustrate the technical difficulties we encountered during the surgery.
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Prashanth A, Datta D, Kumar R, Taywade S, Chandran R, Pandey R. Sub-diaphragmatic haemangioma suspected on F-18 Fdg Pet/Ct confirmed by Rbc scintigraphy. Indian J Nucl Med 2022; 37:189-191. [PMID: 35982803 PMCID: PMC9380792 DOI: 10.4103/ijnm.ijnm_153_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 12/02/2022] Open
Abstract
A 53-year-old woman presented with left submandibular gland carcinoma. Contrast-enhanced computerized tomography done for staging revealed suspicious metastatic omental deposit adjacent to left hemi-diaphragm apart from primary and cervical nodal metastasis. Staging F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography showed high FDG uptake in the primary and metastatic left cervical lymph nodes. However, no FDG uptake was seen in left sub-diaphragmatic mass. Known vascular malformations sites in the left posterior triangle of the neck and liver hemangiomas also showed no uptake. This pattern of uptake raised a suspicion of multiple vascular malformations. Tc-99 m red blood cell scintigraphy was done which confirmed the nature of subdiaphragmatic lesion as haemangioma.
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Song L, Han S, Jiang L, Zhang W. F18-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of vertebral vascular tumors. Clin Imaging 2020; 65:24-32. [PMID: 32353715 DOI: 10.1016/j.clinimag.2020.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE F-FDG PET/CT in vertebral vascular tumors. MATERIALS AND METHODS We retrospectively collected PET/CT and clinical data of patients with vertebral vascular tumors and analyzed the location, number, and bone destruction and FDG uptake features of the lesion. We measured SUVmax and maximum diameter and analyzed the correlations between SUVmax and the pathological results, size, and CT features. RESULTS Twenty-one pathology-proven vertebral vascular tumors were included: 2 angiosarcomas (SUVmax, 11.6 and 32.3), 1 epithelioid hemangioendothelioma (SUVmax, 5.7), 1 epithelioid hemangioma (SUVmax, 8.5), and 17 aggressive hemangiomas. Twelve cases of typical hemangiomas were included as controls. The SUVmax and diameter of the aggressive hemangiomas were higher than those of the typical hemangiomas. The mean SUVmax of aggressive hemangiomas with cortical destruction was higher than that of those without cortical destruction (t = -2.566, P = 0.022). Radioactive distribution in aggressive hemangiomas was homogeneous and heterogeneous in nine and eight cases, respectively. In six aggressive hemangiomas, the FDG uptake of residual and marginal sclerosing bone was higher than that of the osteolytic destruction area and/or paravertebral soft tissue. Six aggressive hemangiomas involved the spinal canal, without clear visualization on PET/CT. CONCLUSION F-FDG PET/CT shows limitations in evaluating the spinal canal involvement of aggressive hemangioma.
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Affiliation(s)
- Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, 100191 Beijing, PR China
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, 100191 Beijing, PR China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 100191 Beijing, PR China
| | - Weifang Zhang
- Department of Nuclear Medicine, Peking University Third Hospital, 100191 Beijing, PR China.
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Elhelf IAS, Pillenahalli Maheshwarappa R, Hodgson J, Hodgson CK, Pollard J, Menda Y. Giant vertebral hemangioma masquerading as aggressive tumor: Tc-99m tagged RBC scan can help to solve the diagnostic conundrum! Radiol Case Rep 2019; 14:1360-1363. [PMID: 31516653 PMCID: PMC6734535 DOI: 10.1016/j.radcr.2019.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/25/2019] [Accepted: 06/23/2019] [Indexed: 10/27/2022] Open
Abstract
Hemangiomas are the most common benign lesions involving the spine. Metastasis is the most common malignant condition. The diagnosis of typical hemangiomas on conventional CT and MRI imaging is straightforward. However, when the hemangiomas are very large they may have atypical features making their diagnosis on these conventional imaging modalities inconclusive. In such cases nuclear medicine techniques such as Tc-99m RBC may aid in resolving the diagnostic conundrum. Awareness and use of proper diagnostic modality can prevent unnecessary biopsy. In this case report we try to highlight the added value of Tc-99m RBC scan to conventional imaging techniques in differentiating giant vertebral hemangioma from more aggressive malignant tumors.
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Affiliation(s)
| | | | - Jared Hodgson
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Christina K Hodgson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Janet Pollard
- Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, USA
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7
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Liver metastasis from adenoid cystic carcinoma: imaging and histologic features. Curr Probl Cancer 2019; 43:331-335. [DOI: 10.1016/j.currproblcancer.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 01/31/2023]
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Miao H, Yang W, Zhou M, Zhu Q, Jiang Z. Atrial Hemangioma: A Case Report and Review of the Literature. Ann Thorac Cardiovasc Surg 2019; 25:71-81. [PMID: 30890668 PMCID: PMC6477455 DOI: 10.5761/atcs.ra.18-00207] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A primary cardiac tumor is a rare clinical entity which was reported an incidence of 0.03% in previous autopsy series. 75% cardiac tumors are cardiac myxoma and cardiac hemangiomas constitute only 1–2% of primary cardiac tumors. With the development of modern medical imaging technology and the enhancement of people’s health awareness, more and more asymptomatic cardiac hemangiomas were found and confirmed eventually. Here, we described a case of a 71-year-old man, who was hospitalized with intermittent palpitation for 1 year and a large mass of the heart was removed successfully via sternotomy which was confirmed as atrial hemangioma by postoperative histopathology. Furthermore, a comprehensive review of atrial hemangioma was conducted to date and a few recommendations for the diagnosis and treatment of this uncommon disorder were provided for clinicians.
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Affiliation(s)
- Huikai Miao
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Wenlong Yang
- Department of Thoracic and Cardiovascular Surgery, Shandong Provincial Lanling People's Hospital, Linyi, China
| | - Mengmeng Zhou
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Taishan Medical University, Taian, China
| | - Qiang Zhu
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
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Ishibashi M, Tanabe Y, Fujii S, Ogawa T. Pictorial review of 18F-FDG PET/CT findings in musculoskeletal lesions. Ann Nucl Med 2017; 31:437-453. [PMID: 28585058 DOI: 10.1007/s12149-017-1182-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022]
Abstract
We herein reviewed 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) findings in a number of musculoskeletal lesions including malignant tumors, benign tumors, and tumor-like lesions with correlations to other radiographic imaging modalities, and described the diversity of the 18F-FDG PET/CT findings of this entity. Malignant primary musculoskeletal tumors are typically 18F-FDG avid, whereas low-grade malignant tumors show mild uptake. Benign musculoskeletal tumors generally show a faint uptake of 18F-FDG, and tumor-like conditions also display various uptake patterns of 18F-FDG. Although musculoskeletal tumors show various uptakes of 18F-FDG on PET/CT, its addition to morphological imaging modalities such as CT and MRI is useful for the characterization and differentiation of musculoskeletal lesions.
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Affiliation(s)
- Mana Ishibashi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan.
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
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Lee WW, So Y, Kang SY, So MK, Kim H, Chung HW, Kim WS, Kim SE. F-18 fluorodeoxyglucose positron emission tomography for differential diagnosis and prognosis prediction of vascular tumors. Oncol Lett 2017; 14:665-672. [PMID: 28693219 PMCID: PMC5494675 DOI: 10.3892/ol.2017.6192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 03/10/2017] [Indexed: 12/26/2022] Open
Abstract
The spectrum of vascular tumors ranges from hemangioma (HEM), to epithelioid hemangioendothelioma (EHE) and to angiosarcoma (AS). To the best of our knowledge, the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for vascular tumors has never been comprehensively studied. The present study investigated the usefulness of FDG-PET for pathologically diagnosed vascular tumors. The present study included 26 patients with vascular tumor (male:female, 17:9; age, 60.9±14.4 years; 7 HEM, 6 EHE and 13 AS) who underwent FDG-PET between January 2007 and May 2014 at the Seoul National University Bundang Hospital (Seongnam, Korea) and Konkuk University Medical Center, (Seoul, Korea). Representative FDG uptake was measured as the maximum standardized uptake value (SUVmax) over the lesion with the highest FDG uptake. Disease progression was clinically defined as the aggravation of known lesions or novel lesion development during follow-up on computed tomography, magnetic resonance imaging, or FDG-PET. FDG-PET revealed multi-organ involvement only in AS (6/13 [46.2%]), whereas HEM and EHE involved a single organ. Tumor SUVmax was significantly greater in AS (6.32±4.84) compared with EHE (3.10±2.68) and HEM (2.33±0.76) (P=0.0284). There was no difference in tumor SUVmax between HEM and EHE (P>0.05). Disease progression was primarily noticed in AS (9/13 [69.2%]). Only 1 patient with EHE (1/6=16.7%) and no patients with HEM (0/7=0%) experienced disease progression. Mortality was reported only in patients with AS (4/13 [30.8%]). Using the cutoff SUVmax of 3.0, the two-year progression-free survival rate of 14 patients with tumor SUVmax <3.0 (75.0%) was significantly higher compared with that of 12 patients with tumor SUVmax ≥3.0 (0%) (P=0.0053). In conclusion, FDG-PET is useful for the differential diagnosis and prognosis prediction of vascular tumors.
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Affiliation(s)
- Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do 13620, Republic of Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
| | - Young So
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Seo Young Kang
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Min-Kyung So
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do 13620, Republic of Korea
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Wan Seop Kim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Sang Eun Kim
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi-do 13620, Republic of Korea
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Abstract
OBJECTIVE The aim of this study was to investigate the features and patterns of skeletal muscle metastases (SMM) detected with F-fluorodeoxyglucose (F-FDG) PET/computed tomography (PET/CT). PARTICIPANTS AND METHODS Our database was analyzed for patients with pathologically proven malignancy, who underwent F-FDG PET/CT in our institution. The patients with SMM were included in the study group on the basis of the final diagnosis confirmed by follow-up or histopathology. Images were acquired using a PET/CT system Biograph mCT S(64)-4R. CT was performed without contrast enhancement. RESULTS The selected group included 31 patients (1.7% of the database, which consisted of 1805 patients). A total of 233 lesions were found. The prevalence of SMM evaluated in specific primary malignancies was the highest in melanoma (6.9%), followed by carcinoma of unknown primary (4.4%), colorectal cancer (4.1%) and lung cancer (2.8%). Three patterns of skeletal muscle metastatic involvement were observed: multiple SMM accompanied by other metastases (64.5%), solitary lesion associated with other metastases (29%) and isolated intramuscular lesions (two cases, 6.5%). Isolated SMM represented recurrence of the malignant disease. In patients with extraskeletal metastases, solitary or multiple SMM did not affect tumor staging. CONCLUSION Solitary SMM are less common than multiple on F-FDG PET/CT imaging. SMM are usually associated with other metastases and do not affect tumor staging. The cases of isolated SMM are very rare. Nevertheless, in patients with a diagnosis of malignant disease, a solitary, F-FDG avid intramuscular focus should be suspected to represent metastasis.
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Abstract
Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor. We present a case, who had a history of a left pulmonary ASPS resection 5 years ago, with a tumor in the left lower extremity showing high vascularity mimicking hemangioma on enhanced CT and MRI. This tumor showed intense FDG uptake on FDG PET/CT with SUVmax of 6.8, indicating a malignant soft tissue tumor. Complete resection of the tumor was performed. A diagnosis of ASPS was confirmed by pathology. This case highlights FDG PET/CT is helpful for differentiating ASPS from hemangioma according the degree of FDG uptake.
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Tanaka Y, Yamada H, Saito T, Nakaoka K, Kumagai K, Fujihara H, Mishima K, Hamada Y. Solitary myofibroma of the mandible in an adult with magnetic resonance imaging and positron emission tomography findings: a case report. World J Surg Oncol 2014; 12:69. [PMID: 24678877 PMCID: PMC4230239 DOI: 10.1186/1477-7819-12-69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 03/15/2014] [Indexed: 11/29/2022] Open
Abstract
Myofibroma is a benign tumor composed of myoid spindle cells. The prevalence of myofibroma in the oral cavity is very low, with the mandible being the most common site. This report describes an adult case of myofibroma that arose on the mandible and includes magnetic resonance imaging (MRI) and positron emission tomography (PET) findings. On the MRI T1-weighted images, the tumor appeared with signal iso-intensity and was highly and heterogeneously enhanced with contrast material. On the T2-weighted images, it appeared with increased signal intensity. 18 F-fluorodeoxyglucose (FDG)-PET imaging showed abnormal strong accumulation of FDG in the left mandibular region. The tumor was removed by marginal resection of the left mandible under general anesthesia. Histopathological findings revealed that the tumor stroma contained abundant thin-walled vessels. The postoperative course was uneventful, and we found no evidence of recurrence at the postoperative 34-month follow-up.
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Affiliation(s)
| | - Hiroyuki Yamada
- Department of Oral and Maxillofacial Surgery, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, Japan.
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Bone Scan, MRI, and FDG PET/CT Findings in Composite Hemangioendothelioma of the Manubrium Sterni. Clin Nucl Med 2014; 39:e180-3. [DOI: 10.1097/rlu.0b013e3182873092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Matsui Y, Mineharu Y, Satow T, Takebe N, Takeuchi E, Saiki M. Coexistence of multiple cavernous angiomas in the spinal cord and skin: a unique case of Cobb syndrome. J Neurosurg Spine 2014; 20:142-7. [DOI: 10.3171/2013.11.spine13419] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cobb syndrome is a rare, noninherited, neurocutaneous disease characterized by vascular abnormality of the spinal cord and is associated with vascular lesions in the skin at the same metamere. The majority of spinal vascular lesions are arteriovenous malformations, and skin lesions are mostly port-wine angiomas. The authors report the first case of multiple intramedullary cavernous angiomas (CAs) accompanied by skin CAs within the same metamere. A 42-year-old man presented with an acute onset of gait disturbance, low-back pain, and urinary incontinence. Magnetic resonance imaging of the thoracolumbar spine showed homogeneously enhanced lesions on a contrast-enhanced T1-weighted image and a hypointense area on a T2*-weighted image surrounding this enhanced lesion, between the T-12 and S-1 levels. Purple protruding skin lesions were detected on the left side of his gluteal region. The patient received a laminectomy followed by evacuation of a hematoma and partial removal of the tumor, which completely resolved his neurological symptoms. Pathological examinations showed that the spinal and skin lesions were CAs, suggesting that these vascular lesions developed congenitally. Cavernous angiomas associated with Cobb syndrome present with multiple lesions spanning more than 3 vertebral levels, making it difficult to completely resect these tumors. Although Cobb syndrome is an uncommon disease entity, it should be considered if a patient manifesting with neurological deficits has skin vascular lesions, including CAs.
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Affiliation(s)
| | | | | | | | - Eiji Takeuchi
- 2Diagnostic Pathology, Shiga Medical Center for Adults, Shiga, Japan
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Matsumoto Y, Takahashi Y, Haraguchi A, Okamoto T, Harimaya K, Matsunobu T, Endo M, Oda Y, Iwamoto Y. Intraosseous hemangioma arising in the clavicle. Skeletal Radiol 2014; 43:89-93. [PMID: 23990112 DOI: 10.1007/s00256-013-1715-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
Abstract
Intraosseous hemangioma (IH) is commonly seen in the vertebral column and skull: however, IH occurring in the appendicular skeleton, including the clavicle, is uncommon. We herein report the case of a 69-year-old female presenting with IH of the left clavicle. The findings of preoperative imaging studies, including radiographs, computed tomography (CT), magnetic resonance imaging, fluorine-18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and ultrasonography, are described. In particular, (18)F-FDG PET/CT showed an ill-defined osteolytic lesion with abnormally high FDG uptake. Surgical en bloc resection with preoperative embolization was carried out and a histopathological examination confirmed the presence of an intraosseous cavernous hemangioma in the clavicle.
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Affiliation(s)
- Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
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18
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Ko SW, Park JG. Cavernous hemangioma of the ilium mimicking aggressive malignant bone tumor with increased activity on (18)F-FDG PET/CT. Korean J Radiol 2013; 14:294-8. [PMID: 23482507 PMCID: PMC3590343 DOI: 10.3348/kjr.2013.14.2.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/17/2012] [Indexed: 12/05/2022] Open
Abstract
Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (18F-FDG) uptake on 18F-FDG PET/CT.
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Affiliation(s)
- Seog Wan Ko
- Department of Diagnostic Radiology, Dong-A Hospital, Gwangju 503-300, Korea.
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Jeong YJ, Yoon HJ, Kang DY. Growing Cardiac Hemangioma on Serial F-18 FDG PET/CT. Nucl Med Mol Imaging 2012; 46:223-6. [PMID: 24900065 DOI: 10.1007/s13139-012-0155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/12/2012] [Accepted: 06/21/2012] [Indexed: 11/30/2022] Open
Abstract
Cardiac hemangiomas are extremely rare, benign tumors, which can occur anywhere in the heart. Symptoms are variable according to the size, extension and tumor location, but most cases are asymptomatic and are detected incidentally. They may grow, remain stable and regress; therefore, the natural course of the tumors is unpredictable. Diagnosis mainly depends upon echocardiography, CT, MRI and angiography. Reports of detection by F-18 FDG PET/CT are very limited. We report a case of cardiac hemangioma attached to the right ventricle, compressing the ventricle. It was revealed incidentally on F-18 FDG PET/CT for routine evaluation of thyroid cancer. During two serial F-18 FDG PET/CTs, it grew from 2.8 cm to 4.0 cm with mild FDG uptake. After surgery, the patient remained stable without any complications.
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Affiliation(s)
- Young Jin Jeong
- Department of Nuclear Medicine, Dong-A University Medical Center, 3ga 1, Dongdaesin-dong, Seo-gu, Busan 602-715 South Korea
| | - Hyun Jin Yoon
- Department of Nuclear Medicine, Dong-A University Medical Center, 3ga 1, Dongdaesin-dong, Seo-gu, Busan 602-715 South Korea
| | - Do-Young Kang
- Department of Nuclear Medicine, Dong-A University Medical Center, 3ga 1, Dongdaesin-dong, Seo-gu, Busan 602-715 South Korea
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Cha JG, Yoo JH, Kim HK, Park JM, Paik SH, Park SJ. PET/CT and MRI of intra-osseous haemangioma of the tibia. Br J Radiol 2012; 85:e94-8. [PMID: 22457416 DOI: 10.1259/bjr/35251836] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intra-osseous haemangioma is a rare, benign neoplasm that usually involves the vertebrae and craniofacial bones. Furthermore, its occurrence in the long bones is extremely rare. We report the findings of fluorine-18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and MRI in a patient with intra-osseous haemangioma in the proximal tibia, who was initially misdiagnosed as having a malignancy based on (18)F-FDG PET/CT. (18)F-FDG PET/CT showed a well-marginated osteolytic lesion with abnormal FDG uptake. The mass demonstrated low signal intensity on T(1) weighted MRI. On T(2) weighted images, the lesion appeared as a cluster of high signal intensity lobules and showed strong enhancement on contrast-enhanced T(1) weighted images. Surgical curettage was performed and histopathological examination of the excised tissue confirmed a cavernous haemangioma.
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Affiliation(s)
- J G Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheonsi, Gyeonggido, Republic of Korea.
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Vieira SC, Silva JSE, Madeira EB, França JCQD, Martins Filho SN. Hemangioma de mama simulando metástase no PET-CT. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000600014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hemangioma de mama é um tumor benigno raro que apresenta pouca ou nenhuma captação de 18F-flúor-2-deoxi-Dglicose (FDG) na tomografia por emissão de pósitrons (PET). Relatamos um nódulo mamário compatível, patologicamente, com hemangioma, em uma mulher cuja PET scan demonstrou captação elevada de FDG (simulando tumor maligno). Também fizemos breve revisão das causas que levam a resultados falso-positivos e falso-negativos pela PET.
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Rajiah P, Kanne JP. Mediastinal vascular malformation presenting with stroke. Br J Radiol 2010; 83:e138-42. [PMID: 20603398 DOI: 10.1259/bjr/68475678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The mediastinum is an uncommon location for vascular malformations. We describe an unusual case of a young patient with a large, extensive mediastinal vascular malformation and draining vein to the left atrium who presented with recurrent ischaemic episodes.
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Affiliation(s)
- P Rajiah
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA.
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Higashiyama S, Kawabe J, Hayashi T, Kurooka H, Oe A, Kotani J, Kawamura E, Shiomi S. A case of cavernous hemangioma in which malignancy was preoperatively excluded by FDG-PET. Ann Nucl Med 2008; 22:327-30. [DOI: 10.1007/s12149-007-0101-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 12/02/2007] [Indexed: 10/22/2022]
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Abstract
Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
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Affiliation(s)
- Dong Hwee Kim
- Department of Physical Medicine & Rehabilitation, Korea University College of Medicine, Ansan Hospital, 516 Gojan-dong, Danwon-gu, Seoul, Korea.
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Suzuki R, Watanabe H, Yanagawa T, Sato J, Shinozaki T, Suzuki H, Endo K, Takagishi K. PET evaluation of fatty tumors in the extremity: possibility of using the standardized uptake value (SUV) to differentiate benign tumors from liposarcoma. Ann Nucl Med 2006; 19:661-70. [PMID: 16444991 DOI: 10.1007/bf02985114] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The relative utility of various preoperative diagnostic imaging modalities, including PET (utilizing FDG and FMT), CT, and MR imaging, for evaluation of lipoma and liposarcoma, especially well-differentiated liposarcoma, was investigated. METHODS Imaging findings in 32 patients with histopathologically documented lipoma, including one with fibrolipoma and one with angiolipoma, and 25 patients with liposarcomas whose subtypes included 10 well-differentiated, 10 myxoid, and 5 other types were reviewed retrospectively. Pre-operative imaging included FDG-PET (n = 44), FMT-PET (n = 21), CT (n = 25), and MR imaging (n = 53). RESULTS Statistically significant imaging features of MR images favoring a diagnosis of liposarcoma involved lesions containing less than 75% fat (p < 0.001) as well as the presence of septa (p < 0.001). As compared with well-differentiated liposarcoma, benign lesions were differentiated significantly only by the presence of septa (p < 0.001), which also provided significant differentiation on CT (p < 0.05). The mean SUVs for malignant tumors were significantly higher than those for benign lesions in both FDG- and FMT-PET analyses (p < 0.0001, p = 0.0011, respectively). By using a cut-off value for FDG- and FMT-PET set at 0.81 and 1.0 respectively, which provided the highest accuracy, benign lesions were differentiated significantly from liposarcomas (p < 0.001, and p < 0.02). Furthermore, benign tumors and the three subtypes of liposarcoma were divided significantly into four biological grades by FDG- and FMT-accumulation rates (rho = 0.793, p < 0.0001; and rho = 0.745, p = 0.0009, respectively). A cut-off value of 0.81 for FDG-PET provided significant differentiation between benign lesions and well-differentiated liposarcoma (p < 0.01). CONCLUSIONS The presence of septa on MR images differentiated lipomas from liposarcoma, even well-differentiated type. PET analysis, especially FDG-PET, quantitatively provided not only the differentiation but also the metabolic separation among subtypes of liposarcoma. Interpretation of the visual diagnostic modalities requires extensive experience and carries a risk of ignoring a critical portion of malignancy. PET metabolic imaging may be an objective and useful modality for evaluating adipose tissue tumors preoperatively.
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Affiliation(s)
- Ryoko Suzuki
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Japan
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Suzuki H, Watanabe H, Shinozaki T, Yanagawa T, Suzuki R, Takagishi K. Positron emission tomography imaging of musculoskeletal tumors in the shoulder girdle. J Shoulder Elbow Surg 2004; 13:635-47. [PMID: 15570232 DOI: 10.1016/j.jse.2004.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The shoulder girdle presents unique features for the preoperative planning of musculoskeletal tumors. This is the first trial to evaluate positron emission tomography (PET) analysis for preoperative planning in shoulder girdle tumors. Fifty-two patients were examined with fluorine 18 fluoro-2-deoxy-D-glucose (FDG)-PET and/or alpha-methyltyrosine (FMT)-PET. Imaging findings were visually inspected in conjunction with computed tomography and/or magnetic resonance imaging, and standardized uptake values (SUVs) were generated. FDG-PET may be useful for the detection of malignant tumors and screening for metastatic spread, with the qualitative assessment of heterogeneous biologic activity providing a correct approach for biopsy. The mean SUVs for malignant tumors were significantly higher than those for benign lesions. However, a useful cutoff SUV was not found in either FDG- or FMT-PET for differentiating malignant from benign tumors from receiver operating characteristic curve analysis. SUVs on FDG- and FMT-PET may merely be limited to differentiating malignant from benign tumors in the shoulder girdle.
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Affiliation(s)
- Hideki Suzuki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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