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Wu X, Meng H, Fan Q, Qi Z, Pan W. Image features and clinical analysis of retroperitoneal pelvic schwannoma: a case report. BMC Neurol 2024; 24:230. [PMID: 38961371 PMCID: PMC11221090 DOI: 10.1186/s12883-024-03715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/06/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. CASE PRESENTATION We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein. CONCLUSIONS Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.
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Affiliation(s)
- Xining Wu
- Department of Ultrasonography, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan NO.1, Dongcheng District, Beijing, China
| | - Hua Meng
- Department of Ultrasonography, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan NO.1, Dongcheng District, Beijing, China.
| | - Qingbo Fan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan NO.1, Dongcheng District, Beijing, China.
| | - Zhenhong Qi
- Department of Ultrasonography, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan NO.1, Dongcheng District, Beijing, China
| | - Weidong Pan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan NO.1, Dongcheng District, Beijing, China
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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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3
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Horak S, Cierna Z, Kopecka I, Drozda V, Harmanos M, Cvik M. Ancient retroperitoneal schwannoma imitating seminoma recurrence: A case report. Urol Case Rep 2022; 46:102304. [PMID: 36582515 PMCID: PMC9792343 DOI: 10.1016/j.eucr.2022.102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
A 28-year-old male with bilateral testicular seminoma underwent bilateral orchiectomy and radiation therapy of the retroperitoneum. After 17 years, he had a retroperitoneal tumor detected, which was removed 7 years later at age 52 because of its progressive enlargement. Due to its partially cystic and partially solid structure, the radiologic findings could not exclude the possibility of regressively altered seminoma metastasis. After radical surgical removal of the tumor, the histopathological and immunohistochemical examination of the tumor revealed ancient schwannoma. These tumors, although unusual, might pose a clinical diagnostic challenge with the risk of undesired overtreatment.
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Affiliation(s)
- Samuel Horak
- Department of Pathology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Zuzana Cierna
- Department of Pathology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia,Department of Pathology, Faculty of Health Care and Social Work, Trnava University and University Hospital, Trnava, Slovakia,Corresponding author. Department of Pathology, Faculty of Medicine, Comenius University and University Hospital, Sasinkova 4, 811 08, Bratislava, Slovakia.
| | - Iveta Kopecka
- Department of Pathology, Faculty of Health Care and Social Work, Trnava University and University Hospital, Trnava, Slovakia
| | - Vladimir Drozda
- Department of Urology, University Hospital, Trnava, Slovakia
| | - Michal Harmanos
- Department of Urology, University Hospital, Trnava, Slovakia
| | - Marian Cvik
- Department of Urology, University Hospital, Trnava, Slovakia
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Haleem S, Mahmoud MH, Singh Kainth G, Botchu R, Hassan MF. 18F-FDG PET/CT scan standardised uptake value (SUV) score for diagnosis, staging and monitoring malignancy in spinal melanotic schwannoma. J Surg Case Rep 2022; 2022:rjac524. [PMCID: PMC9731614 DOI: 10.1093/jscr/rjac524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022] Open
Abstract
Abstract
Melanotic schwannoma (MS) is a rare nerve sheath neuroectodermal neoplasm. We highlight the use of F18-fluorodeoxyglucose positive emission tomography/computed tomography (18F-FDG PET/CT) standardised uptake value (SUV) results in the diagnosis, staging and monitoring of spinal MS. A 58-year-old female patient had a 6-month history of left leg pain (S1) and no skin lesions. Magnetic resonance imaging reported a possible schwannoma with CT-guided biopsy, indicating a metastatic malignant melanoma. 18F-FDG PET/CT scan revealed only sacral destruction and an SUV score of 3.6. Histopathology results confirmed a malignant melanotic peripheral nerve sheath tumour (schwannoma). In MS, the 18F-FDG PET/CT scan SUV cut-off point can be used to distinguish between benign and malignant lesions, whereas (SUVmax) can predict the histologic response and therefore useful as a ‘screening test’. Our case highlights the increased uptake on PET/CT by melanocytic variant of neurogenic tumours and clinicians need to be aware of this.
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Affiliation(s)
| | - Mohamed H Mahmoud
- Suez Canal University Neurosurgery Department, , Ismailia 41522 , Egypt
| | | | - Rajesh Botchu
- Royal Orthopaedic Hospital , Birmingham B31 2AP , UK
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Pancreatic schwannoma: Case report, clinico-pathologic correlation, and review of the literature. Radiol Case Rep 2022; 17:3504-3510. [PMID: 35912298 PMCID: PMC9334929 DOI: 10.1016/j.radcr.2022.07.029] [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: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Schwannomas are common peripheral nerve sheath tumors that typically occur on the head, neck, trunk, or extremities. Intra-abdominal schwannomas, however, are rare. We describe a young woman who presented for imaging evaluation of suspected nephrolithiasis and was incidentally found to have a schwannoma centered within the pancreatic parenchyma. In addition, we detail the clinical, imaging, and histopathologic features of pancreatic schwannoma and summarize diagnosis and management of this rare clinical entity.
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Xu SY, Zhou B, Wei SM, Zhao YN, Yan S. Successful treatment of pancreatic schwannoma by enucleation: A case report. Medicine (Baltimore) 2022; 101:e28874. [PMID: 35244041 PMCID: PMC8896508 DOI: 10.1097/md.0000000000028874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pancreatic schwannomas are extremely rare and are difficult to diagnose preoperatively. Over the past 50 years, only 96 cases of pancreatic schwannoma have been reported in English literature. Herein, we report a case of pancreatic schwannoma treated with enucleation. PATIENT CONCERNS A 66-year-old woman visited a local hospital due to ventosities. Ultrasonography and computed tomography revealed a pancreatic mass. She visited our hospital for further diagnosis and treatment. DIAGNOSIS AND INTERVENTIONS Magnetic resonance imaging revealed a tumor in the pancreatic body, and a solid pseudopapillary tumor was considered preoperatively. During the surgery, a pancreatic mass was found growing in the pancreatic body and tail. A successful tumor enucleation was performed. The mass was 7 × 6 × 3 cm in size with a thin capsule. Pathological examination revealed that the tumor was mainly composed of spindle-shaped cells with a palisading arrangement and no atypia. Both hypercellular and hypocellular areas were visible. Immunohistochemical staining showed that protein S-100 was strongly positive. The tumor was diagnosed as a benign schwannoma originating from the pancreatic body and tail. OUTCOMES Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications. LESSONS Pancreatic schwannomas are extremely rare and difficult to diagnose using imaging examinations. Enucleation is a safe and efficacious treatment for exophytic pancreatic schwannomas.
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Affiliation(s)
- Shao-Yan Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Bo Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Shu-Mei Wei
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Ya-Nan Zhao
- Department of Ultrasound, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, Hangzhou, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang Province, China
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Ravikanth R. 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging review of benign lesions of the thorax. World J Nucl Med 2020; 20:7-16. [PMID: 33850484 PMCID: PMC8034779 DOI: 10.4103/wjnm.wjnm_85_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 12/02/2022] Open
Abstract
2-deoxy-2-(Fluorine-18) fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) has been used exclusively to diagnose malignancies. However, increased 18F-FDG uptake is not always limited to malignant lesions. This imaging review demonstrates the physiological 18F-FDG uptake of normal structures in the thorax and illustrates many benign pathological lesions with standardized uptake value >2.5. These various conditions can be broadly categorized into three groups: infective lesions, active granulomatous diseases such as sarcoidosis, noninfectious/inflammatory, or proliferative conditions such as radiation pneumonitis, postlung transplant lymphoproliferative disorders, occupational pleuropulmonary complications, and postsurgical conditions, all of which can demonstrate varying degrees of 18F-FDG uptake on PET/CT based upon the degree of inflammatory activity. Familiarity of false-positive findings improves the PET/CT evaluation accuracy of benign lesions of the thorax. Radiation exposure and surgical history correlation along with imaging cross check evaluation of radiographs and magnetic resonance images for the anatomic location remains the mainstay of PET/CT characterization of positive findings.
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Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, St. John's Hospital, Kattappana, Kerala, India
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Pancreatic schwannoma, an extremely rare and challenging entity: Report of two cases and review of literature. Pancreatology 2019; 19:729-737. [PMID: 31153779 DOI: 10.1016/j.pan.2019.05.460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Pancreatic schwannoma is a rare benign tumor, for which the preoperative and intraoperative definitive diagnosis is quite challenging. We present the clinical, radiological and pathologic features of two primary pancreatic schwannomas identified in our pathology database over a period of 30 years at our tertiary care hospital. To better understand the clinico-pathological and radiological features of this entity, we provide a comprehensive review of 73 cases described in the English literature, along with our two cases. This review will especially focus on preoperative and intraoperative diagnosis to assess their accuracy for pancreatic schwannoma. The three most common preoperative diagnoses based on imaging for pancreatic schwannomas were cystic neoplasm (56%), pancreatic neuroendocrine tumor (29%) and mucinous cystic neoplasm (26%). Imaging could not definitely diagnose pancreatic schwannoma in any of the reported cases. To obtain a definite diagnosis before surgery, 25 cases underwent imaging-guided fine-needle aspiration (FNA)/biopsy, of which 60% were correctly reported as benign with definite diagnosis of pancreatic schwannoma in 48%. A higher diagnostic accuracy was observed in biopsies (71%) than FNA (37%). In addition, an intraoperative frozen section was carried out in 15 cases, and 47% were correctly diagnosed. Despite relatively low accuracy, preoperative histological assessment can be helpful in surgical managment. A core tissue specimen is recommended to improve the diagnostic accuracy in this setting.
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Wang S, Xing C, Wu H, Dai M, Zhao Y. Pancreatic schwannoma mimicking pancreatic cystadenoma: A case report and literature review of the imaging features. Medicine (Baltimore) 2019; 98:e16095. [PMID: 31192973 PMCID: PMC6587594 DOI: 10.1097/md.0000000000016095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Schwannomas, also known as neurilemmoma, are benign neoplasms that originating from Schwann cells in peripheral nerve sheaths. The head, neck, and extremities are the most common sites; however, pancreatic schwannomas are rare neoplasms. Accurate preoperative diagnosis of these tumors is very tough because of pancreatic schwannomas usually mimicking other cystic tumors. Here we present a case of pancreatic schwannoma misdiagnosed as pancreatic cystadenoma. PATIENT CONCERNS We presented a rare case of a 55-year-old female admitted to our hospital for abdominal distension. The physical examination and results of laboratory testing reveal no abnormalities. DIAGNOSIS A computed tomography (CT) scan detected a hypodense 2.4 cm × 2.6 cm mass with a clear margin at the neck of the pancreas. Pancreatic cystadenoma was strongly suspected. INTERVENTIONS The patient underwent robotic distal pancreatectomy with splenectomy. The gross specimen showed a pale and solid mass with a capsule. OUTCOMES Histological examination of the surgical specimen demonstrated a pancreatic schwannoma. Immunohistochemistry results were as follows: S-100 (+), CD117 (-), SMA (-), and Desmin (-). She was discharged on postoperative day 6 and no recurrence of the tumor happened during the 12-month follow-up. CONCLUSION Precise preoperative diagnosis of pancreatic schwannomas is very difficult despite the application of multiple imaging modalities. Surgery is the most effective treatment for this rare disease and the final diagnosis usually relies on pathology. Following complete tumor removal, patients with pancreatic schwannomas generally have a good prognosis.
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Affiliation(s)
| | | | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
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10
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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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11
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Lieber B, Han B, Allen J, Fatterpekar G, Agarwal N, Kazemi N, Zagzag D. Utility of positron emission tomography in schwannomatosis. J Clin Neurosci 2016; 30:138-140. [PMID: 26960263 DOI: 10.1016/j.jocn.2016.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
Schwannomatosis is characterized by multiple non-intradermal schwannomas with patients often presenting with a painful mass in their extremities. In this syndrome malignant transformation of schwannomas is rare in spite of their large size at presentation. Non-invasive measures of assessing the biological behavior of plexiform neurofibromas in neurofibromatosis type 1 such as positron emission tomography (PET), CT scanning and MRI are well characterized but little information has been published on the use of PET imaging in schwannomatosis. We report a unique clinical presentation portraying the use of PET imaging in schwannomatosis. A 27-year-old woman presented with multiple, rapidly growing, large and painful schwannomas confirmed to be related to a constitutional mutation in the SMARCB1 complex. Whole body PET/MRI revealed numerous PET-avid tumors suggestive of malignant peripheral nerve sheath tumors. Surgery was performed on multiple tumors and none of them had histologic evidence of malignant transformation. Overall, PET imaging may not be a reliable predictor of malignant transformation in schwannomatosis, tempering enthusiasm for surgical interventions for tumors not producing significant clinical signs or symptoms.
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Affiliation(s)
- Bryan Lieber
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #507, Little Rock, AR 72205, USA.
| | - ByoungJun Han
- New York University School of Medicine, New York, NY, USA
| | - Jeffrey Allen
- Department of Pediatric Neuro-oncology, New York University School of Medicine, New York, NY, USA
| | - Girish Fatterpekar
- Department of Neuroradiology, New York University School of Medicine, New York, NY, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Noojan Kazemi
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #507, Little Rock, AR 72205, USA
| | - David Zagzag
- Department of Neuropathology, New York University School of Medicine, New York, NY, USA
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Ramia JM, de la Plaza R, Alonso S, Gijón L, Valenzuela J. "Ancient" schwannoma in the psoas muscle. Cir Esp 2016; 94:e37-9. [PMID: 25790906 DOI: 10.1016/j.ciresp.2015.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/10/2015] [Accepted: 01/25/2015] [Indexed: 02/07/2023]
Affiliation(s)
- José Manuel Ramia
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Roberto de la Plaza
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Soledad Alonso
- Servicio de Anatomía Patológica, Hospital Universitario de Guadalajara,Guadalajara, España
| | - Luis Gijón
- Servicio de Radiología, Hospital Universitario de Guadalajara,Guadalajara, España
| | - José Valenzuela
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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Nishizawa N, Kumamoto Y, Hirata M, Watanabe M. Retroperitoneal schwannoma between the inferior vena cava and the abdominal aorta resected by laparoscopic surgery: A case report. Asian J Endosc Surg 2015; 8:361-4. [PMID: 26303739 DOI: 10.1111/ases.12192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/09/2015] [Accepted: 03/23/2015] [Indexed: 11/30/2022]
Abstract
A 22-year-old woman presented with backache. Imaging analysis revealed a retroperitoneal tumor, 40 mm in diameter, surrounded by the abdominal aorta, inferior vena cava, caudate lobe of liver, and the left renal vein. The tumor consisted of multilocular cystic parts, and a solid part showed contrast enhancement. The possibility of malignancy could not be excluded, so we planned a laparoscopic tumorectomy. After placement of a transjugular vascular sheath for an occlusion balloon catheter in the inferior vena cava, the operation was performed with six ports. There was a strong fibrotic adhesion between the tumor and the abdominal aorta, with other weak adhesions. The tumor was successfully resected by a laparoscopic operation with minimal bleeding. The histopathological diagnosis was a benign schwannoma. This case demonstrates that a retroperitoneal tumor adjacent to major vessels can be resected safely by laparoscopic surgery if the surgeon is especially careful of the possibility of accidental bleeding.
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Affiliation(s)
- Nobuyuki Nishizawa
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yusuke Kumamoto
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mitsuhiro Hirata
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Ohbatake Y, Makino I, Kitagawa H, Nakanuma S, Hayashi H, Nakagawara H, Miyashita T, Tajima H, Takamura H, Ninomiya I, Fushida S, Fujimura T, Ohta T. A case of pancreatic schwannoma - The features in imaging studies compared with its pathological findings: Report of a case. Clin J Gastroenterol 2014; 7:265-70. [PMID: 26183748 DOI: 10.1007/s12328-014-0480-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/16/2014] [Indexed: 12/15/2022]
Abstract
Pancreatic schwannoma is a very rare tumor that tends to be confused with other pancreatic tumors preoperatively. We report a case of schwannoma of the pancreatic head. A 40-year-old woman was admitted to our hospital for treatment of a pancreatic tumor which was found by medical checkup. It was a well-defined solid tumor exhibiting heterogeneous enhancement with some necrotic foci on contrast-enhanced computed tomography (CT) and on magnetic resonance imaging (MRI). Angiography and CT during arteriography revealed the main feeding arteries of the tumor to be the posterior and anterior superior pancreaticoduodenal arteries. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) showed accumulation of FDG in the tumor with a maximum standardized uptake value of 3.6. We diagnosed a solid pseudopapillary neoplasm or a pancreatic neuroendocrine tumor preoperatively and performed pylorus-preserving pancreaticoduodenectomy. The tumor had well a well-defined capsule and was composed of a large solid portion containing spindle cells and a smaller hemorrhagic portion containing hypocellular stroma, and diagnosed as pancreatic schwannoma by immunohistochemistry. In this case, CT during arteriography was useful in determining the origin of the tumor. MRI reflected the pathological features of the tumor. The most important finding was that FDG-PET showed abnormal accumulation of FDG in the benign pancreatic schwannoma.
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Affiliation(s)
- Yoshinao Ohbatake
- Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan,
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15
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Unexpected Diagnosis of Peripheral Schwannoma on 18F-Fluoroethylcholine PET/CT for Localization of Prostate Cancer Recurrence and Biopsy Under Real-Time PET/Ultrasound Fusion Guidance. Clin Nucl Med 2014; 39:385-6. [DOI: 10.1097/rlu.0000000000000375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Unique surgical issues in the management of a giant retroperitoneal schwannoma and brief review of literature. Case Rep Med 2014; 2014:781347. [PMID: 24790608 PMCID: PMC3970245 DOI: 10.1155/2014/781347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/06/2014] [Indexed: 11/18/2022] Open
Abstract
Ancient Schwannoma, though benign, can cause diagnostic dilemma because of its clinical presentation and imaging features. We report the management of a giant retroperitoneal schwannoma in a 19-year-old young lady who presented with lower abdominal distension. CT scan reported a large heterogenous lesion in the abdominopelvic retroperitoneum (42 cm × 16 cm × 16 cm) as a malignant tumor. The unique problems we encountered were the enormous size, the location of major part of the tumor in the pelvis, the need for fertility preservation, the external iliac vessels stretching over the tumor making mobilization surgically demanding, and the prospects of neurological deficits. An en bloc resection of schwannoma with common iliac, external iliac and internal iliac veins, internal iliac artery, femoral and obturator nerves, and iliopsoas muscle was done maintaining oncological principles. External iliac artery that was cut to facilitate tumor mobilization was reanastomosed at the end of the procedure. Postoperatively patient had uneventful recovery with patchy sensory loss, foot drop, and quadriceps weakness which was rehabilitated with a foot drop splint and active physiotherapy.
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Esophageal schwannoma: report of a case and review of the literature. Eur Surg 2014. [DOI: 10.1007/s10353-014-0252-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lower Neck Neurilemmoma Can Masquerade as Lymph Node Metastasis on FDG PET/CT in Patient With Nasopharyngeal Carcinoma. Clin Nucl Med 2011; 36:e217-9. [DOI: 10.1097/rlu.0b013e31822920db] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Aggarwal G, Satsangi B, Shukla S, Lahoti BK, Mathur RK, Maheshwari A. Rare asymptomatic presentations of schwannomas in early adolescence: three cases with review of literature. Int J Surg 2010; 8:203-6. [PMID: 20167297 DOI: 10.1016/j.ijsu.2010.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 01/05/2010] [Accepted: 01/14/2010] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Schwannoma also known as Neurilemoma is a benign neoplasm of the Schwann Cells of the neural sheath. They are usually found to occur in the extremities, but can also be found in the trunk, head and neck, pelvis, and rectum. It is seldom painful and usually remains small. It has no potential for malignancy unless the patient has multi-neural tumours. It usually presents as a slowly enlarging painless nodule somewhat movable beneath the surface, rarely becomes larger than 2cm in diameter and is most frequently diagnosed in 25-55 yrs of age. PATIENTS AND METHODS We report three rare, asymptomatic presentations of schwannomas at adolescent age, in the back, pancreas and in the cervical region with a review of the available literature. CONCLUSION Despite the rarity of the presentations, as encountered by us, similar swellings in the adolescent age group can be schwannomas and can be adequately managed surgically alone. This is what should be borne in mind, for 'what the mind knows is what the eyes see'.
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Affiliation(s)
- Gaurav Aggarwal
- Department of Surgery, M.G.M Medical College & M.Y.H Group of Hospitals, Indore, Madhya Pradesh 452001, India.
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Loevner LA, Kim AK, Mikityansky I. PET/CT-MR Imaging in Head and Neck Cancer Including Pitfalls and Physiologic Variations. PET Clin 2009; 3:335-53. [PMID: 27156665 DOI: 10.1016/j.cpet.2009.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article emphasizes the strengths and potential pitfalls of functional and anatomic imaging in patients who have head and neck cancer with an emphasis on the treated neck, including patients who have undergone surgery and/or radiation therapy. Anatomic and molecular imaging together allow optimal evaluation and interpretation of a patient who has cancer. Effective assessment of patients who have head and neck cancer can be achieved through a careful review of pertinent anatomy, with awareness of the physiologic variations (especially those in the treated head and neck) seen in PET imaging, and analysis of both the PET and cross-sectional images.
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Affiliation(s)
- Laurie A Loevner
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Ann K Kim
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Igor Mikityansky
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Matsuki A, Kosugi S, Kanda T, Komukai S, Ohashi M, Umezu H, Mashima Y, Suzuki T, Hatakeyama K. Schwannoma of the esophagus: a case exhibiting high 18F-fluorodeoxyglucose uptake in positron emission tomography imaging. Dis Esophagus 2009; 22:E6-E10. [PMID: 19473209 DOI: 10.1111/j.1442-2050.2007.00712.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal schwannoma is rare and it is difficult preoperatively to confirm a definitive diagnosis, even using current imaging techniques. We present a case of a benign esophageal schwannoma that was surgically excised and confirmed by immunohistochemical staining. Conventional radiological studies, including barium meal, computed tomography and endoscopic examination had shown a solid submucosal tumor of the upper thoracic esophagus but had been unable to confirm the diagnosis. Positron emission tomography was carried out to evaluate the malignant potential and showed a high uptake of 18F-fluorodeoxyglucose (FDG) into the tumor in both the early and delayed phase, suggesting that the tumor was a potentially malignant tumor such as a gastrointestinal stromal tumor. This is the first reported case of esophageal schwannoma that indicated a high FDG uptake. Although consensus has not been reached regarding the precise mechanism of FDG accumulation in schwannomas, we discuss our clinicopathological findings and review other studies of the subject.
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Affiliation(s)
- A Matsuki
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Choudry HA, Nikfarjam M, Liang JJ, Kimchi ET, Conter R, Gusani NJ, Staveley-O'Carroll KF. Diagnosis and management of retroperitoneal ancient schwannomas. World J Surg Oncol 2009; 7:12. [PMID: 19187535 PMCID: PMC2645401 DOI: 10.1186/1477-7819-7-12] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 02/02/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ancient schwannomas are degenerate peripheral nerve sheath tumors that very rarely occur in the retroperitoneum. They generally reach large proportions before producing symptoms due to mass effect. We describe three cases of retroperitoneal ancient schwannomas and discuss the diagnosis and management of these tumors. CASE PRESENTATIONS Three female patients with retroperitoneal ancient schwannomas were reviewed. One patient presented with several weeks of upper abdominal pain and lower chest discomfort, whereas back pain and leg pain with associated weakness were predominant symptoms in the remaining two. Abdominal imaging findings demonstrated heterogeneous masses in the retroperitoneum with demarcated margins, concerning for malignancy. The patients successfully had radical excision of their tumors. Histological examination showed encapsulated tumors that displayed alternating areas of dense cellularity and areas of myxoid matrix consistent with a diagnosis of ancient schwannoma. CONCLUSION A diagnosis of ancient schwannoma should be entertained for any heterogeneous, well encapsulated mass in the retroperitoneum. In these cases less radical surgical resection should be considered as malignant transformation of these tumors is extremely rare and recurrence is uncommon following excision.
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Affiliation(s)
- Haroon A Choudry
- Department of Surgery, University Hospitals, Case Medical Center, Cleveland, OH, USA.
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Sadok Boudaya M, Dechaud C, Gossot D, Validire P, Magdeleinat P, Moretti JL. Un cas de schwannome bénin avec hypermétabolisme sur la tomoscintigraphie TEP au 18fluorodésoxyglucose. Rev Mal Respir 2009; 26:63-5. [DOI: 10.1016/s0761-8425(09)70136-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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Bensaid B, Giammarile F, Mognetti T, Galoisy-Guibal L, Pinson S, Drouet A, Combemale P. Intérêt de la tomographie par émission de positons au fluorodéoxyglucose 18 dans la détection des neurofibrosarcomes au cours de la neurofibromatose de type 1. Ann Dermatol Venereol 2007; 134:735-41. [DOI: 10.1016/s0151-9638(07)92528-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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OTA M, NAKAMURA T, OGUMA H, NARUMIYA K, KUDO K, YAMAMOTO M. A CASE OF A SCHWANNOMA OF THE ESOPHAGUS SHOWING HIGH RADIOTRACER CONCENTRATION IN FDG-PET. ACTA ACUST UNITED AC 2007. [DOI: 10.3919/jjsa.68.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hamada K, Tomita Y, Ueda T, Enomoto K, Kakunaga S, Myoui A, Higuchi I, Yoshikawa H, Hatazawa J. Evaluation of delayed18F-FDG PET in differential diagnosis for malignant soft-tissue tumors. Ann Nucl Med 2006; 20:671-5. [PMID: 17385305 DOI: 10.1007/bf02984678] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) has been used for the evaluation of soft-tissue tumors. However, the range of accumulation of 18F-FDG for malignant soft-tissue lesions overlaps with that of benign lesions. The aim of this study is to investigate the usefulness of delayed 18F-FDG PET imaging in the differentiation between malignant and benign soft-tissue tumors. METHODS Fifty-six patients with soft-tissue tumors underwent whole body 18F-FDG PET scan at 1 hour (early scan) and additional scan at 2 hours after injection (delayed scan). The standardized uptake value (SUV(max)) of the tumor was determined, and the retention index (RI) was defined as the ratio of the increase in SUV(max) between early and delayed scans to the SUV(max) in the early scan. Surgical resection with histopathologic analysis confirmed the diagnosis. RESULTS Histological examination proved 19 of 56 patients to have malignant soft-tissue tumors and the rest benign ones. In the scans of all 56 patients, there was a statistically significant difference in the SUV(max) between malignant and benign lesions in the early scan (5.50 +/- 5.32 and 3.10 +/- 2.64, respectively, p < 0.05) and in the delayed scan (5.95 +/- 6.40 and 3.23 +/- 3.20, respectively, p < 0.05). The mean RI was not significantly different between malignant and benign soft-tissue tumors (0.94 +/- 23.04 and -2.03 +/- 25.33, respectively). CONCLUSIONS In the current patient population, no significant difference in the RI was found between malignant and benign soft-tissue lesions. Although the mean SUV(max) in the delayed scan for malignant soft-tissue tumors was significantly higher than that for benign ones, there was a marked overlap. The delayed 18F-FDG PET scan may have limited capability to differentiate malignant soft-tissue tumors from benign ones.
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Affiliation(s)
- Kenichiro Hamada
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Chang CY, Fan YM, Bai CY, Cherng SC. Schwannoma Mimicking Lung Cancer Metastases Demonstrated by PET/CT. Clin Nucl Med 2006; 31:644-5. [PMID: 16985377 DOI: 10.1097/01.rlu.0000238130.18526.39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chih-Yung Chang
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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