- Email: [email protected]
CT imaging
G Model REMNIM-763; No. of Pages 3
ARTICLE IN PRESS Rev Esp Med Nucl Imagen Mol. 2015;xxx(xx):xxx–xxx
Interesting image
Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging Tumor de células gigantes pulmonar primario: imágenes 18 F-FDG PET/CT R.S. Plowman, B.D. Nguyen ∗ Department of Radiology, Nuclear Medicine Division, Mayo Clinic Arizona, Scottsdale, AZ, USA
A 63 year-old man consulted our institution for a slow-growing right lung mass detected in mid-2014. His medical history was remarkable for hypothyroidism and a previously resected nodalpositive squamous cell carcinoma of the tongue base treated with chemoradiation 10 years prior, without interval evidence of recurrence. He initially presented with a single episode of hemoptysis without cough or dyspnea. Chest radiographs showed a 4–5 cm right lower pulmonary lobe mass (Fig. 1A). Chest CT scan confirmed the mass with a non-diagnostic ensuing lung biopsy (Fig. 1B). Whole body fluorine-18 fluorodeoxyglucose positron emission computed tomography (18 F-FDG PET/CT) was performed showing a borderline hypermetabolic right lower lobe mass abutting but sparing the pleura (SUV 3.1, Fig. 1C). No additional hypermetabolic lesion was detected within the remainder of the body. The patient underwent a video-assisted thoracoscopic surgery and right lower lobectomy with the final histological diagnosis of pulmonary giant cell lesion with secondary features of aneurysmal bone cyst (Fig. 2). Pathology detected no malignant features. There were positive CD163 and CD68 markers suggesting a histiocytic origin and some features of hemorrhage. The patient has since
undergone skeletal surveys which were negative for any bony lesions. Giant cell tumors (GCT) have been described as rare locally aggressive, albeit benign, tumors of bone aptly named for characteristic large multinucleated monocytes/histiocytes seen on histology.1–3 GCT has a propensity to metastasize with the majority occurring within the lung parenchyma.1 Notably, more recent studies have shown that despite a benign classification, giant cell tumors display 18 F-FDG uptake with a mean SUV of 4.8 (range 1.8–9.4), largely attributed to their enhanced vascular fraction and augmented radiotracer transport.3 Despite their rarity, such tumors have been reported with extraskeletal primary locations involving the gastrointestinal tract, liver, pancreas, breast, ovary, thyroid, kidney and lung.2 Among the rare published cases of primary pulmonary GCT, none had documented the use of PET/CT or molecular imaging. In our case presentation, PET/CT imaging, in addition to the detailed evaluation of the right lower lung lesion, established the diagnosis of primary lung origin of GCT by the absence of any GCT of the axial and appendicular skeleton, thus ruling out osseous GCT with potential pulmonary metastasis.
∗ Corresponding author. E-mail address: [email protected] (B.D. Nguyen). http://dx.doi.org/10.1016/j.remn.2015.11.004 2253-654X/© 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
Please cite this article in press as: Plowman RS, Nguyen BD. Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015. http://dx.doi.org/10.1016/j.remn.2015.11.004
G Model REMNIM-763; No. of Pages 3 2
ARTICLE IN PRESS R.S. Plowman, B.D. Nguyen / Rev Esp Med Nucl Imagen Mol. 2015;xxx(xx):xxx–xxx
Fig. 1. (A) Chest radiographs showing the right lower lung mass (arrows). (B) CT confirming the mildly and heterogeneously contrast-enhancing right lower pulmonary lobe mass in axial, sagittal and coronal projections (arrows). (C) Axial, sagittal and coronal PET/CT images showing the borderline hypermetabolic primary lung Giant cell tumor (circles).
Please cite this article in press as: Plowman RS, Nguyen BD. Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015. http://dx.doi.org/10.1016/j.remn.2015.11.004
G Model REMNIM-763; No. of Pages 3
ARTICLE IN PRESS R.S. Plowman, B.D. Nguyen / Rev Esp Med Nucl Imagen Mol. 2015;xxx(xx):xxx–xxx
3
Fig. 2. (A) Video-assisted thoracoscopic gross specimen of giant cell tumor with a chocolate brown, soft, spongy, and friable tumor exhibiting yellowish-to-orange discoloration secondary to the presence of hemosiderin. The tumor approaches the pleura but there was no transpleural extension. (B) Photomicrograph of the giant cell tumor reveals a typical appearance with multinucleated giant cells with centrally located nuclei dispersed throughout a background of mononuclear stromal cells. The mononuclear cells are mostly plump and oval-shaped and there is prominent mitotic activity present (Courtesy from Dr. T.V. Colby from the Department of Laboratory Medicine).
Conflict of interest The authors have no conflict of interest to declare.
2. Orosz Z, Tóth E, Viski A. Osteoclastoma-like giant cell tumor of the lung. Pathol Oncol Res. 1996;2:84–8. 3. Strauss LG, Dimitrakopoulou-Strauss A, Koczan D, Bernd L, Haberkorn U, Ewerbeck V, et al. 18F-FDG kinetics and gene expression in giant cell tumors. J Nucl Med. 2004;45:1528–35.
References 1. Chan CM, Adler Z, Reith JD, Gibbs CP Jr. Risk factors for pulmonary metastases from giant cell tumor of bone. J Bone Joint Surg Am. 2015;97:420–8.
Please cite this article in press as: Plowman RS, Nguyen BD. Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015. http://dx.doi.org/10.1016/j.remn.2015.11.004
ARTICLE IN PRESS Rev Esp Med Nucl Imagen Mol. 2015;xxx(xx):xxx–xxx
Interesting image
Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging Tumor de células gigantes pulmonar primario: imágenes 18 F-FDG PET/CT R.S. Plowman, B.D. Nguyen ∗ Department of Radiology, Nuclear Medicine Division, Mayo Clinic Arizona, Scottsdale, AZ, USA
A 63 year-old man consulted our institution for a slow-growing right lung mass detected in mid-2014. His medical history was remarkable for hypothyroidism and a previously resected nodalpositive squamous cell carcinoma of the tongue base treated with chemoradiation 10 years prior, without interval evidence of recurrence. He initially presented with a single episode of hemoptysis without cough or dyspnea. Chest radiographs showed a 4–5 cm right lower pulmonary lobe mass (Fig. 1A). Chest CT scan confirmed the mass with a non-diagnostic ensuing lung biopsy (Fig. 1B). Whole body fluorine-18 fluorodeoxyglucose positron emission computed tomography (18 F-FDG PET/CT) was performed showing a borderline hypermetabolic right lower lobe mass abutting but sparing the pleura (SUV 3.1, Fig. 1C). No additional hypermetabolic lesion was detected within the remainder of the body. The patient underwent a video-assisted thoracoscopic surgery and right lower lobectomy with the final histological diagnosis of pulmonary giant cell lesion with secondary features of aneurysmal bone cyst (Fig. 2). Pathology detected no malignant features. There were positive CD163 and CD68 markers suggesting a histiocytic origin and some features of hemorrhage. The patient has since
undergone skeletal surveys which were negative for any bony lesions. Giant cell tumors (GCT) have been described as rare locally aggressive, albeit benign, tumors of bone aptly named for characteristic large multinucleated monocytes/histiocytes seen on histology.1–3 GCT has a propensity to metastasize with the majority occurring within the lung parenchyma.1 Notably, more recent studies have shown that despite a benign classification, giant cell tumors display 18 F-FDG uptake with a mean SUV of 4.8 (range 1.8–9.4), largely attributed to their enhanced vascular fraction and augmented radiotracer transport.3 Despite their rarity, such tumors have been reported with extraskeletal primary locations involving the gastrointestinal tract, liver, pancreas, breast, ovary, thyroid, kidney and lung.2 Among the rare published cases of primary pulmonary GCT, none had documented the use of PET/CT or molecular imaging. In our case presentation, PET/CT imaging, in addition to the detailed evaluation of the right lower lung lesion, established the diagnosis of primary lung origin of GCT by the absence of any GCT of the axial and appendicular skeleton, thus ruling out osseous GCT with potential pulmonary metastasis.
∗ Corresponding author. E-mail address: [email protected] (B.D. Nguyen). http://dx.doi.org/10.1016/j.remn.2015.11.004 2253-654X/© 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
Please cite this article in press as: Plowman RS, Nguyen BD. Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015. http://dx.doi.org/10.1016/j.remn.2015.11.004
G Model REMNIM-763; No. of Pages 3 2
ARTICLE IN PRESS R.S. Plowman, B.D. Nguyen / Rev Esp Med Nucl Imagen Mol. 2015;xxx(xx):xxx–xxx
Fig. 1. (A) Chest radiographs showing the right lower lung mass (arrows). (B) CT confirming the mildly and heterogeneously contrast-enhancing right lower pulmonary lobe mass in axial, sagittal and coronal projections (arrows). (C) Axial, sagittal and coronal PET/CT images showing the borderline hypermetabolic primary lung Giant cell tumor (circles).
Please cite this article in press as: Plowman RS, Nguyen BD. Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015. http://dx.doi.org/10.1016/j.remn.2015.11.004
G Model REMNIM-763; No. of Pages 3
ARTICLE IN PRESS R.S. Plowman, B.D. Nguyen / Rev Esp Med Nucl Imagen Mol. 2015;xxx(xx):xxx–xxx
3
Fig. 2. (A) Video-assisted thoracoscopic gross specimen of giant cell tumor with a chocolate brown, soft, spongy, and friable tumor exhibiting yellowish-to-orange discoloration secondary to the presence of hemosiderin. The tumor approaches the pleura but there was no transpleural extension. (B) Photomicrograph of the giant cell tumor reveals a typical appearance with multinucleated giant cells with centrally located nuclei dispersed throughout a background of mononuclear stromal cells. The mononuclear cells are mostly plump and oval-shaped and there is prominent mitotic activity present (Courtesy from Dr. T.V. Colby from the Department of Laboratory Medicine).
Conflict of interest The authors have no conflict of interest to declare.
2. Orosz Z, Tóth E, Viski A. Osteoclastoma-like giant cell tumor of the lung. Pathol Oncol Res. 1996;2:84–8. 3. Strauss LG, Dimitrakopoulou-Strauss A, Koczan D, Bernd L, Haberkorn U, Ewerbeck V, et al. 18F-FDG kinetics and gene expression in giant cell tumors. J Nucl Med. 2004;45:1528–35.
References 1. Chan CM, Adler Z, Reith JD, Gibbs CP Jr. Risk factors for pulmonary metastases from giant cell tumor of bone. J Bone Joint Surg Am. 2015;97:420–8.
Please cite this article in press as: Plowman RS, Nguyen BD. Primary pulmonary giant cell tumor: 18 F-FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015. http://dx.doi.org/10.1016/j.remn.2015.11.004