PET/CT has had an evolutionary role in Oncology. Gynecological malignancies have been increasing in incidence in the last decades. Delay in diagnosis and management have led to worsening prognosis among the patients. Lowering the... more
PET/CT has had an evolutionary role in Oncology. Gynecological malignancies have been increasing in incidence in the last decades. Delay in diagnosis and management have led to worsening prognosis among the patients. Lowering the threshold in suspecting these tumors, may significantly improve the patients’ overall survival. In this review we will address the role of FDG-PET/CT in diagnosing, staging, assessing the response to therapy and predicting survival in gynecological malignancies, namely endometrial, ovarian and cervical cancer. We will briefly compare the diagnosing ability of PET/MRI to PET/CT. We will address the interesting fact about simultaneously utilizing the Apparent Diffusion Coefficient (ADC) with the Standardized Uptake Value (SUV) in hybrid MRI imaging and we will also discuss about the role of PET/MRI in diagnosing primary and recurrent gynecological malignancies.
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Research Interests: Radiology, Incidence Geometry, Research, Positron Emission Tomography, Medicine, and 15 moreThyroid, Thyroid Cancer, Canadian, Humans, Female, Male, Incidental Findings, Clinical Sciences, Papillary Squamous Cell Carcinoma, Middle Aged, Adult, Retrospective Studies, Radiopharmaceuticals, Malignancy, and Thyroid Neoplasms
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Nuclear or molecular imaging (N/MI) is a functional imaging method, which utilizes radiopharmaceuticals (RPHs) to prepare the patient and special detectors to map and measure the distribution of the administered RPHs inside the body. RPHs... more
Nuclear or molecular imaging (N/MI) is a functional imaging method, which utilizes radiopharmaceuticals (RPHs) to prepare the patient and special detectors to map and measure the distribution of the administered RPHs inside the body. RPHs are biologically active molecules labeled with radioactive isotopes (or radionuclides). They target either normal tissues or specific pathology (e.g., tumors, infection, etc.) and are administered in absolutely safe and harmless small quantities. N/MI provides a noninvasive evaluation of patients with or at risk of developing cerebral palsy and predicts outcome of these patients. It has also an established role for the localization of seizure foci in epilepsy, which is present in approximately two fifths of patients with cerebral palsy. Novel PET tracers that are used in some neurological centers image gamma-aminobutyric acid (GABA) receptor with 18F-fluoroflumazenil and serotonin function with 11C-alpha-methyl-l-tryptophan, and these have the potential to become the standard of care in the future.
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10531 Background: Soft-tissue sarcoma spreads predominantly to the lung. It is currently unclear how often PET scan will detect metastases not already obvious by chest imaging or clinical examination. Methods: Soft-tissue sarcoma cases... more
10531 Background: Soft-tissue sarcoma spreads predominantly to the lung. It is currently unclear how often PET scan will detect metastases not already obvious by chest imaging or clinical examination. Methods: Soft-tissue sarcoma cases were identified retrospectively. Ewing's sarcoma, rhabdomyosarcoma and GIST tumors were excluded as were patients imaged for follow-up, response assessment or recurrence. Patients all had had a diagnostic chest CT scan as part of their staging. Directed studies were requested to follow-up on abnormal findings in the clinical history or physical examination. All charts and pre-treatment imaging were reviewed retrospectively. Results: From 2004 to 2008, 75 patients met the criteria for this review. These 75 patients had total body FDG-PET/CT imaging on routine initial staging of their sarcoma. The median age was 51. In 21% of cases, the primary tumor had been removed by excisional biopsy or unplanned excision prior to staging. 97% of the previously unresected primary tumors were FDG avid (SUV ≥ 2). 81% of tumors were high-grade (FNCLCC Grade 2–3). The primary tumor was stage T2b in 68% of cases. The most common primary site was the lower extremity (55%). The most common pathological diagnoses were: leiomyosarcoma (21%), liposarcoma (19%) and synovial sarcoma (17%). At the end of staging, 17% of patients were considered to have metastatic disease. PET scans were negative for distant disease in 64/75 cases. Seven of these 64 cases had metastatic disease on chest CT (negative predictive value 89%). 8 PET scans were positive - of these, 4 patients were already known to have metastases, 2 were pathologically proven false positives and 1 was a new finding of a pulmonary metastasis (sensitivity 46%). Three patients had indeterminate PET scans (subsequently none developed metastatic disease). Two incidental benign parotid tumors were found. In total, only 1 patient was upstaged by the PET imaging (1.3%). In addition, PET did not alter management of patients already know to have M1 disease (no new organ sites identified). Conclusions: Although PET scans may be of use in specific circumstances, routine use of FDG PET imaging for detection of metastatic disease as part of the initial staging of soft-tissue sarcoma adds little to chest CT scanning and is unlikely to alter management. No significant financial relationships to disclose.
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A lack of FDG-PET response to neoadjuvant chemotherapy for gastroesophageal adenocarcinoma is considered as indicative of a poor prognosis, whereas pathologic complete or near-complete response (pCR/near-pCR) predicts a more favorable... more
A lack of FDG-PET response to neoadjuvant chemotherapy for gastroesophageal adenocarcinoma is considered as indicative of a poor prognosis, whereas pathologic complete or near-complete response (pCR/near-pCR) predicts a more favorable outcome. In a single-arm phase II trial of perioperative immunochemotherapy, we sought to establish a correlation between the results of an FDG-PET performed after the neoadjuvant part of the treatment and the pathologic results obtained after surgery. Methods Inclusion criteria: locally advanced gastroesophageal adenocarcinoma (T3 and/or N+); adequate organ function; ECOG PS 0–1; no contraindication to immunotherapy; Staging: CT, FDG-PET, EUS, diagnostic laparoscopy. Eligible patients receive docetaxel/cisplatin/5-FU (mDCF) on day 1 and avelumab on day 4 of each 2-week cycle and are restaged after 4 cycles. FDG-PET response is defined as reduction of >35% of pre-treatment SUV. Surgery is performed if no disease progression. Four cycles of mDCF/avelumab are administered after surgery. Tumor regression is scored from 0 (no tumor cells) to 3 (no tumor regression). The primary endpoint is the pCR/near-PCR rate (score 0–1). Results As of February 24, 2020, 28 patients have been enrolled and 22 have been operated. Paired FDG-PET response and pathologic response data are available for 21 patients. We observed 16/21 FDG-PET responses and 6/21 pCR/near-pCR. Of the latter, 4 were associated with an FDG-PET response and 2 with no FDG-PET response. Ten patients with score 3 tumor regression had had FDG-PET response. No statistical correlation could be found between FDG-PET response and likelihood of pCR/near-pCR. Conclusion Given the discrepancy observed between FDG-PET and pathologic results, the need for a repeat FDG-PET for gastroesophageal adenocarcinoma after neoadjuvant immunochemotherapy and before surgery should be questioned. Analysis of the tumor microenvironment could possibly explain these results. Future studies will look into correlation between the results presented and survival.
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To study the possibility of incorporating positron emission tomography/computed tomography (PET/CT) information into radiotherapy treatment planning in patients with high-grade soft tissue sarcomas (STS). We studied 17 patients treated... more
To study the possibility of incorporating positron emission tomography/computed tomography (PET/CT) information into radiotherapy treatment planning in patients with high-grade soft tissue sarcomas (STS). We studied 17 patients treated with preoperative radiotherapy at our institution from 2005 to 2007. All patients had a high-grade STS and had had a staging PET/CT scan. For each patient, an MRI-based gross tumor volume (GTV), considered to be the contemporary standard for radiotherapy treatment planning, was outlined on a T1-gadolinium enhanced axial MRI (GTV(MRI)), and a second set of GTVs were outlined using different threshold values on PET images (GTV(PET)). PET-based target volumes were compared with the MRI-based GTV. Threshold values for target contouring were determined as a multiple (from 2 to 10 times) of the background soft tissue uptake values (B) sampled over healthy tissue. PET-based GTVs contoured using a threshold value of 2 or 2.5 most closely resembled the GTV(MRI) volumes. Higher threshold values lead to PET volumes much smaller than the GTV(MRI). The standard deviations between the average volumes of GTV(PET) and GTV(MRI) ratios for all thresholds were large, ranging from 36% for 2 xB up to 93% for 10 xB. Maximum uptake-to-background ratio correlated poorly with the maximum standardized uptake values. It is unlikely that PET/CT will make a significant contribution in GTV definition for radiotherapy treatment planning in patients with STS using threshold methods on PET images. Future studies will focus on molecular imaging and tumor physiology.
Research Interests: Radiology, Computed Tomography, Magnetic Resonance Imaging, MRI, Radiation Therapy, and 15 moreNuclear medicine, Positron Emission Tomography, Medicine, Molecular Imaging, Humans, PET imaging, Sarcoma, Ct Scan, Clinical Sciences, Leg, Retrospective Studies, Soft Tissue Sarcoma, Soft Tissue, Radiopharmaceuticals, and Contouring
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Nuclear or molecular imaging (N/MI) is a functional imaging method, which utilizes radiopharmaceuticals (RPHs) to prepare the patient and special detectors to map and measure the distribution of the administered RPHs inside the body. RPHs... more
Nuclear or molecular imaging (N/MI) is a functional imaging method, which utilizes radiopharmaceuticals (RPHs) to prepare the patient and special detectors to map and measure the distribution of the administered RPHs inside the body. RPHs are biologically active molecules labeled with radioactive isotopes (or radionuclides). They target either normal tissues or specific pathology (e.g., tumors, infection, etc.) and are administered in absolutely safe and harmless small quantities. N/MI provides a noninvasive evaluation of patients with or at risk of developing cerebral palsy and predicts outcome of these patients. It has also an established role for the localization of seizure foci in epilepsy, which is present in approximately two fifths of patients with cerebral palsy. Novel PET tracers that are used in some neurological centers image gamma-aminobutyric acid (GABA) receptor with 18F-fluoroflumazenil and serotonin function with 11C-alpha-methyl-l-tryptophan, and these have the potential to become the standard of care in the future.
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Background Perioperative chemotherapy improves cure rate in locally advanced esophagogastric and gastric adenocarcinoma. Immunotherapy is active at the metastatic stage. Our hypothesis is that the addition of avelumab, an anti-PD-L1... more
Background Perioperative chemotherapy improves cure rate in locally advanced esophagogastric and gastric adenocarcinoma. Immunotherapy is active at the metastatic stage. Our hypothesis is that the addition of avelumab, an anti-PD-L1 antibody, to perioperative chemotherapy, will increase pathologic complete response (pCR), a potential surrogate for overall survival, compared to historical controls. Methods Single-arm phase II study of avelumab + chemotherapy (modified DCF) given every 2 weeks for 4 cycles before and after surgery. Main inclusion criteria: gastric or gastro-esophageal adenocarcinoma, locally advanced disease, adequate organ function, performance status 0-1, stages Ib, II and III. Main exclusion criteria: other histologies, metastatic disease, use of immunosuppressants, serious autoimmune disease, daily intake of more than 10 mg of prednisone (or equivalent). Statistical hypothesis: this experimental regimen will result in a 20% pCR rate compared to 7% observed with ch...
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95 Background: Perioperative chemotherapy improves outcomes of surgery for upper GI cancer. Some patients have rapid recurrence. We hypothesized that any type of response to chemotherapy would predict better disease-free survival (DFS).... more
95 Background: Perioperative chemotherapy improves outcomes of surgery for upper GI cancer. Some patients have rapid recurrence. We hypothesized that any type of response to chemotherapy would predict better disease-free survival (DFS). Methods: From May 2007 to Sep 2009, 43 patients with operable adenocarcinoma of the esophagus, stomach or gastroesophageal junction went on a multicenter phase II trial. 3 cycles of docetaxel/cisplatin/5FU were given pre and post surgery. We compared DFS between responders and nonresponders after 3 cycles. Clinical response was defined as improvement of ≥ 2 points on a dysphagia score (0: normal swallowing, to 4: total obstruction), metabolic response as ≥ 35% reduction of maximum SUV by PET scan. Lack of nodal involvement or significant histologic regression (less than 50% viable tumor) was considered pathologic response. Log-rank test was used for univariate analysis, Cox regression model for multivariate analysis. All p values are double sided, me...
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ABSTRACT
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F-18 FDG-PET CT imaging is being used more and more often, leading to a developing and clearer understanding of the significant findings and artifacts on these studies. Many of the pitfalls related to F-18 FDG-PET CT studies are easy to... more
F-18 FDG-PET CT imaging is being used more and more often, leading to a developing and clearer understanding of the significant findings and artifacts on these studies. Many of the pitfalls related to F-18 FDG-PET CT studies are easy to recognize. This article illustrates some common pitfalls.
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Research Interests: Gastroenterology, Medicine, Inflammatory Bowel Disease, Prospective studies, Humans, and 15 moreChild, Pelvic Imaging, Female, Male, Pediatric radiology, Monoclonal Antibodies, Colonoscopy, Correlation coefficient, Monoclonal Antibody, Disease Activity, Erythrocyte Sedimentation Rate, Prospective Study, Inflammatory Bowel Diseases, Nino, and Paediatrics and reproductive medicine
Research Interests: Pain, Palliative Care, Radiation Therapy, Adolescent, Medicine, and 15 moreHumans, Child, Female, Male, Infant, Pediatric, Newborn Infant, Neuroblastoma, Retrospective Studies, Pediatric Hematology Oncology, Radiopharmaceuticals, Child preschool, Neoplasm staging, Blood platelets, and Cardiovascular medicine and haematology
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Extraosseous osteosarcomas account for less than 5% of all osteosarcomas. Primary osteosarcoma of the thyroid is a very rare tumor, with only 28 cases described in the published data. This is a case of a 40-year-old woman, 3 months... more
Extraosseous osteosarcomas account for less than 5% of all osteosarcomas. Primary osteosarcoma of the thyroid is a very rare tumor, with only 28 cases described in the published data. This is a case of a 40-year-old woman, 3 months postpartum, who presented with a rapidly growing mass in the neck, causing airway obstruction. An F-18 FDG PET-CT showed a large intensely FDG-avid mass in the thyroid gland, which was histopathologically confirmed to be a primary thyroid osteosarcoma. The patient was treated with tracheostomy, radiation therapy, and 2 cycles of chemotherapy. A posttherapy F-18 FDG PET-CT scan showed that the thyroid osteosarcoma was responding to therapy; however, the patient had developed new lung metastases.
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Background: Brown adipose tissue (BAT) activity on (18)F-fluorodeoxyglucose (FDG) PET/CT can introduce an undesirable element of complexity when attempting to discern physiologic activity from more ominous entities. Recent studies have... more
Background: Brown adipose tissue (BAT) activity on (18)F-fluorodeoxyglucose (FDG) PET/CT can introduce an undesirable element of complexity when attempting to discern physiologic activity from more ominous entities. Recent studies have demonstrated several methods to reduce BAT FDG uptake. Benzodiazepines, however, have yet to been proven effective against BAT. Methods: Twenty-five patients with increased BAT FDG uptake were selected retrospectively from our PET/CT database between November 2004 and January 2011. These patients had been asked to return on a different day for repeat scanning with 5mg of intravenous diazepam, administered ten minutes prior to FDG. Two patients underwent this procedure on a second occasion (for a follow-up scan at a later date), thus resulting in a total of twenty-seven scans from twenty five patients. FDG uptake in BAT was recorded using the maximum standardized uptake value (SUVmax). Results: The mean basal BAT SUVmax was 10.1 ± 4.6 compared to a mean SUVmax of 2.8 ± 3.3 post IV diazepam (p < 0.0001). Approximately 89% (24 of 27) of scans had no significant residual BAT activity. The three remaining scans had a reduction in SUVmax ranging from 23-64% following diazepam administration. No adverse effects were noted. Conclusion: We observed a significant reduction in brown fat activity in para-spinal, cervical, mediastinal, para-adrenal, and supra- and infra-clavicular regions on PET/CT following premedication with intravenous diazepam. We feel that IV benzodiazepines should be considered a pharmacologic option for reducing BAT FDG uptake, which in turn, will aid in distinguishing physiologic metabolic activity from pathology.
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Research Interests: Radiology, Positron Emission Tomography, Medicine, Humans, Female, and 15 moreMale, Multimodal imaging, Clinical Sciences, Aged, Middle Aged, Clinical Imaging, Image Enhancement, Adult, Urinary System, Radiopharmaceuticals, X ray Computed Tomography, Broad Spectrum, Urinary Bladder, Malignancy, and Urinary bladder neoplasms
Research Interests: Treatment Outcome, Surgical Oncology, Positron Emission Tomography, Medicine, Multivariate Analysis, and 15 moreHumans, Female, Male, Sarcoma, Aged, Middle Aged, Adult, Prognosis, Soft Tissue, Radiopharmaceuticals, Predictive value of tests, Extremities, Disease Free Survival, Neoplasm staging, and hazard ratio
18F-FDG PET has reached widespread application in the assessment of pulmonary nodules. This study compares the diagnostic accuracy of standard 18F-FDG PET scanning with those of dual time point 18F-FDG PET scanning. Methods: Thirty-six... more
18F-FDG PET has reached widespread application in the assessment of pulmonary nodules. This study compares the diagnostic accuracy of standard 18F-FDG PET scanning with those of dual time point 18F-FDG PET scanning. Methods: Thirty-six patients (21 women, 15 men; mean age, 67 y; range, 36-88 y) with 38 known or suspected malignant pulmonary nodules underwent PET of the thorax at 2 time points: scan 1 at 70 min (range, 56-110 min) and scan 2 at 123 min (range, 100-163 min) after the intravenous injection of 2.5 MBq 18F-FDG per kilogram of body weight. All scanning was performed on a dedicated C-PET scanner. The mean interval between the scans was 56 min (range, 49-64 min). Regions of interest were overlaid onto each fully corrected image in the areas of the radiographically known lung densities. The standardized uptake values (SUVs) were calculated for both time points. Results: Surgical pathology and follow-up revealed 19 patients with 20 malignant tumors, whereas 16 patients had benign lesions. The tumor SUVs (mean +/- SD) were 3.66 +/- 1.95 (scan 1) and 4.43 +/- 2.43 (scan 2) (20.5% +/- 8.1% increase; P < 0.01). Four of 20 malignant tumors had SUVs of <2.5 on scan 1 (range, 1.12-1.69). Benign lesions had SUVs of 1.14 +/- 0.64 (scan 1) and 1.11 +/- 0.70 (scan 2) (P = not significant). Standard PET scanning (single time point) with a threshold SUV of 2.5 (at time point 1) reached a sensitivity of 80% and a specificity of 94%; dual time point scanning with a threshold value of 10% increase between scan 1 and scan 2 reached a sensitivity of 100% with a specificity of 89%. Conclusion: Dual time point 18F-FDG PET results in a very high sensitivity and specificity for detection of malignant lung tumors.
Research Interests: Nuclear medicine, Medicine, Nuclear, Humans, Female, and 12 morePubmed, Male, Clinical Sciences, Aged, Oral Squamous Cell Carcinoma (OSCC), Single Photon Emission Computed Tomography, Time Factors, Radiopharmaceuticals, Sensitivity and Specificity, Adenocarcinoma, Solitary pulmonary nodule, and lung neoplasms
This is quite an innovative study that should lead to a multicentre validation trial. We have developed an FDG-PET/MRI texture-based model for the prediction of lung metastases (LM) in newly diagnosed patients with soft-tissue sarcomas... more
This is quite an innovative study that should lead to a multicentre validation trial. We have developed an FDG-PET/MRI texture-based model for the prediction of lung metastases (LM) in newly diagnosed patients with soft-tissue sarcomas (STSs) using retrospective analysis. In this work, we assess the model performance using a new prospective STS cohort. We also investigate whether incorporating hypoxia and perfusion biomarkers derived from FMISO-PET and DCE-MRI scans can further enhance the predictive power of the model. A total of 66 patients with histologically confirmed STSs were used in this study and divided into two groups: a retrospective cohort of 51 patients (19 LM) used for training the model, and a prospective cohort of 15 patients (two patients with LM, one patient with bone metastases and suspicious lung nodules) for testing the model. In the training phase, a model of four texture features characterising tumour sub-region size and intensity heterogeneities was developed for LM prediction from pre-treatment FDG-PET and MRI scans (T1-weighted, T2-weighted with fat saturation) of the retrospective cohort, using imbalance-adjusted bootstrap statistical resampling and logistic regression multivariable modeling. In the testing phase, this multivariable model was applied to predict the distant metastasis status of the prospective cohort. The predictive power of the obtained model response was assessed using the area under the receiver-operating characteristic curve (AUC). In the exploratory phase of the study, we extracted two heterogeneity metrics from the prospective cohort: the area under the intensity-volume histogram of pre-treatment DCE-MRI volume transfer constant parametric maps and FMISO-PET hypoxia maps (AU-IVH-Ktrans, AU-IVH-FMISO). The impact of the addition of these two individual metrics to the texture-based model response obtained in the testing phase was first investigated using Spearman9s correlation (rs), and lastly using logistic regression and leave-one-out cross-validation (LOO-CV) to account for overfitting bias. First, the texture-based model reached an AUC of 0.94, a sensitivity of 1, a specificity of 0.83 and an accuracy of 0.87 when tested in the prospective cohort. In the exploratory phase, the addition of AU-IVH-FMISO did not improve predictive power, yielding a correlation of rs = −0.42 (p = 0.12) with lung metastases, and a relative change in validation AUC of 0% in comparison with the texture-based model response alone in LOO-CV experiments. In contrast, the addition of AU-IVH-Ktrans improved predictive power, yielding a correlation of rs = −0.54 (p = 0.04) with lung metastases, and a change in validation AUC of +10%. Our results demonstrate that texture-based models extracted from pre-treatment FDG-PET and MRI anatomical scans could be successfully used to predict distant metastases in STS cancer. Our results also suggest that the addition of perfusion heterogeneity metrics may contribute to improving model prediction performance.
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Research Interests: Radiology, Ultrasound, Ovarian Cancer, Positron Emission Tomography, Medicine, and 13 moreAbdominal Imaging, Humans, Female, Differential Diagnosis, Multimodal imaging, Clinical Sciences, Aged, Neoplasm Invasiveness, Radiopharmaceuticals, X ray Computed Tomography, Abdominal Pain, Neoplasm staging, and Peritoneal Neoplasms
Research Interests: Radiology, Positron Emission Tomography, Medicine, Biopsy, Acute Myeloid Leukemia, and 13 moreHumans, Male, Sarcoma, Karyotyping, Differential Diagnosis, Clinical Sciences, Adult, Pericardium, X ray Computed Tomography, Fluorodeoxyglucose, Whole Body Imaging, Mediastinal neoplasms, and Fatal outcome
A 73-year-old man suffering from Cowden syndrome with gastrointestinal polyposis was referred for an F-FDG PET/CT after a routine gastroscopic biopsy revealed a poorly differentiated adenocarcinoma. The F-FDG PET/CT identified 2 foci of... more
A 73-year-old man suffering from Cowden syndrome with gastrointestinal polyposis was referred for an F-FDG PET/CT after a routine gastroscopic biopsy revealed a poorly differentiated adenocarcinoma. The F-FDG PET/CT identified 2 foci of FDG-avid gastric adenocarcinoma on the background of extensive gastric and colorectal polyposis, and correctly staged the disease, which guided management toward a total gastrectomy. This rare case highlights the usefulness of F-FDG PET/CT in the staging of gastric malignancy in Cowden syndrome.
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A 28-year-old woman with a history of prior bilateral retinoblastoma presented with general fatigue, anemia, and a urinary bladder mass seen on abdominal ultrasound and CT. She was referred for a staging 18F-FDG PET/CT, which showed an... more
A 28-year-old woman with a history of prior bilateral retinoblastoma presented with general fatigue, anemia, and a urinary bladder mass seen on abdominal ultrasound and CT. She was referred for a staging 18F-FDG PET/CT, which showed an intensely FDG-avid bladder mass that was biopsied to reveal a leiomyosarcoma, with no evidence of metastases, which guided her management. 18F-FDG PET/CT is routinely used in the evaluation of leiomyosarcomas; however, its use in the staging of a leiomyosarcoma of the urinary bladder has not been previously described in the literature. This case highlights the usefulness of PET/CT in the staging of this rare tumor.
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A 30-year-old woman was referred for an F-18 fluorodeoxyglucose (FDG) PET/CT to rule out lymphoma, and was found to have an incidental FDG-avid right breast nodule that grew significantly in size and FDG uptake on a subsequent scan,... more
A 30-year-old woman was referred for an F-18 fluorodeoxyglucose (FDG) PET/CT to rule out lymphoma, and was found to have an incidental FDG-avid right breast nodule that grew significantly in size and FDG uptake on a subsequent scan, raising suspicion of a growing breast malignancy. Histologic evaluation showed a complex fibroadenoma with adenosis and surrounding ductal hyperplasia. Although variable F-18 FDG uptake in fibroadenomas has been described, a distinction between simple and complex fibroadenomas has not been made in the PET literature, even though complex fibroadenomas have a higher propensity to develop into malignancies. This case shows that a rapidly growing complex fibroadenoma can mimic a breast malignancy on serial F-18 FDG PET/CT scans, showing significant increase in both size and FDG-avidity on follow-up studies.
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Abstract:Giant cell tumor is a benign but aggressive bone tumor that occurs in young adults ages 20 to 40, accounts for 20% of benign bone tumors, occurs mostly in the metaphyso-epiphyseal region of long bones, and is characterized by the... more
Abstract:Giant cell tumor is a benign but aggressive bone tumor that occurs in young adults ages 20 to 40, accounts for 20% of benign bone tumors, occurs mostly in the metaphyso-epiphyseal region of long bones, and is characterized by the presence of multinucleated giant cells. The risk of malignant
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Malignant extrarenal rhabdoid tumor (ERRT) is a very rare type of soft-tissue sarcoma with a reported incidence of 0.3% of all soft-tissue sarcomas. Only 7 cases of spinal malignant ERRT have been reported in the literature, and to our... more
Malignant extrarenal rhabdoid tumor (ERRT) is a very rare type of soft-tissue sarcoma with a reported incidence of 0.3% of all soft-tissue sarcomas. Only 7 cases of spinal malignant ERRT have been reported in the literature, and to our knowledge, F-18 FDG PET/CT imaging for staging and evaluation of response to therapy for these tumors has not been previously described. This is a case of an 8-month-old boy with malignant ERRT of the spine, who was staged with F-18 FDG PET/CT, and had his tumor burden assessed with PET/CT after chemotherapy, which altered the subsequent chemotherapy regimen.
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Angiomatoid fibrous histiocytoma is a very rare tumor that accounts for 0.3% of all soft-tissue tumors, and occurs predominantly in the extremities of adolescents and young adults. It has been classified by the World Health Organization... more
Angiomatoid fibrous histiocytoma is a very rare tumor that accounts for 0.3% of all soft-tissue tumors, and occurs predominantly in the extremities of adolescents and young adults. It has been classified by the World Health Organization as a tumor of uncertain differentiation with intermediate malignant potential, although recent evidence suggests a myoid or myofibroblastic cell origin. Most examples behave in an indolent manner with a regional recurrence rate of 15% and a rate of metastasis of 1%. We present a 29-year-old woman who was referred for an F-18 FDG PET/CT to evaluate a left shoulder mass. She had multiple local FDG-avid lymph nodes, and initial biopsy was suggestive of epithelioid sarcoma. She was treated with chemotherapy, but a post-therapy PET/CT showed minimal response and radical surgical excision was performed. The histopathology and immunohistochemistry was consistent with angiomatoid fibrous histiocytoma. This case highlights a potential new utility for F-18 FDG PET/CT in the staging and evaluation of response to therapy for this very rare soft-tissue tumor.