FDG PET/CT Image for a Rosai-Dorfman Disease With Pituitary and Bone Involvement in a Pediatric Patient

FDG PET/CT in Isolated Thoracic Vertebral Rosai-Dorfman Disease

ABSTRACT

Isolated osseous Rosai-Dorfman disease is rare. We describe FDG PET/CT findings of solitary thoracic vertebral Rosai-Dorfman disease without extraosseous involvement. The vertebral lesion caused osteolytic destruction of the vertebral body and showed intense FDG uptake.

Gonadotropin-Secreting Pituitary Macroadenoma Complicated With Hemorrhagic Apoplexy in 18F-FDG PET/CT

ABSTRACT

We report the case of 69-year-old man referred for a stage IV pulmonary adenocarcinoma and presenting a decrease in visual acuity. An 18F-FDG PET/CT showed an intense and heterogeneous uptake of a mass in the sellar region. An MRI showed a pituitary macroadenoma associated with a large cyst on the left side, with necrosis zones and fluid level, compressing the optic chiasma. Endocrine testing showed a panhypopituitarism, and pathology confirmed a pituitary apoplexy in a gonadotropin-secreting macroadenoma. No malignant cells were detected. Molecular imaging could have an important role in the detection and characterization of pituitary tumors.

Rosai-Dorfman disease mimicking images of meningiomas: Two case reports and literature review

Background:

Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytic proliferative disorder classically as a massive cervical lymphadenopathy. However, over the years, extranodal locations were confirmed with the central nervous system involvement in less than 5% of cases, which is marked as a significant differential diagnosis of meningiomas, with which they are widely confused due to the similarity of their radiological images.

Case Description:

We report a 37-year-old man and 45-year-old man who were diagnosed with intracranial RDD but whose radiological images mimic meningiomas, requiring anatomopathological and tumor’s immunohistochemistry for definitive diagnosis. Moreover, a review of 184 publications with 285 cases of intracranial involvement of this disease was also performed, comparing these findings with those brought in the previous studies.

Conclusion:

Intracranial Rosai-Dorfman tumors should always be remembered as differential diagnosis of meningiomas since they are similar radiologically and macroscopically. Once remembered and diagnosed, the lesion must be treated following the same pattern of resection done in meningiomas and, treatment’s differences will not occur in the surgical excision technique, but in complementary chemotherapy implementation, radiotherapy, and even with radiosurgery aid, depending on the case. Thus, it is possible to obtain better results than with just the isolated surgical procedure.

Diagnosis and treatment of Rosai-Dorfman disease of the spine: a systematic literature review

PURPOSE

To review and summarize the clinical features, diagnosis, treatment strategies, and prognosis of spinal Rosai-Dorfman disease (RDD).

METHODS

RDD is also termed as sinus histiocytosis with massive lymphadenopathy. We searched the databases of PubMed, Elsevier ScienceDirect, SpringerLink, and OVID. The keywords were Rosai-Dorfman disease and spine/central nervous system. Research articles and case reports with accessibility to full texts regarding spinal RDD were eligible for the inclusion. A total of 62 articles were included, and they contained 69 cases. We extracted the information of interest and analyzed them using SPSS statistics package.

RESULTS

The average age was 33.1 ± 18.3 years. The ratio of males to females was 1.9/1. Overall, 63 cases presented with spine-related symptoms. A total of 27 cases (39.1%) had multi-organ lesions, and 12 cases had records of massive lymphadenopathy. Among 47 cases who first manifested spine-related symptoms, 93.6% were preoperatively misdiagnosed. The disease had a predilection for cervical spine (38.8%) and thoracic spine (40.3%). 62.9% of lesions were dura-based. Surgery remained the mainstream treatment option (78.8%), with or without adjuvant therapies. Total lesion resection was achieved in 34.8% of cases. The rate of lesion recurrence/progression was 19.5%, which was marginally lower for total resection than for non-total resection.

CONCLUSION

Spinal RDD has no pathognomonic clinical and imaging features. Most cases first present with spine-relevant symptoms. Massive lymphadenopathy is not common, but a tendency for multi-organ involvement should be considered. Spinal RDD has a high recurrence rate; thus, total resection is the treatment of choice. Adjuvant therapies are indicated for multi-organ lesions and residual lesions. A wait and watch strategy is recommended for asymptomatic patients. Herein, a workflow of diagnosis and treatment of the spinal RDD is established.

Pituitary Metastases Discovered by 18F-FDG PET/CT During Other Cancers Monitoring: Are There Any Differences of SUVs Between Benign and Malignant Diseases?

F-FDG PET/CT might discover incidental pituitary lesions. We present the case of a 46-year-old woman with breast cancer metastasis in her pituitary. We analyzed 10,347 FDG PET/CT examinations from a tertiary center, finding 4 cases (0.038%) of pituitary metastatic disease from other cancers. We analyzed the differences between SUVmax in cases of physiological high uptake, primary tumor, and hypophysis metastases from other cancers in our database compared with the literature.

Potential role of 18F-FDG PET/CT in a case of progressive Rosai Dorfman disease

Rosai Dorfman disease is a rare form of nonlangerhans cell histiocytosis, presenting with extensive lymphadenopathies. Treatment in most cases of nodal disease, involves close observation; however, extranodal involvement requires a more definitive treatment strategy. Herein, we report a case of extensive Rosai Dorfman disease in a 43-year-old woman presenting for evaluation of treatment response by 18F-FDG PET/CT after frequent relapses and disease progression. In addition to extensive lymphadenothapies in cervical, supraclavicular, superior mediastinum, axillary, abdominopelvic and inguinofemoral regions, the patient had metabolically active bone and subcutaneous lesions which were not previously recognized. Following this 18F-FDG PET/CT study, the patient management was changed to sirolimus and prednisolone. To choose the best treatment option for Rosai Dorfman patients, knowledge of the full extent of disease is important. Compared with conventional imaging, 18F-FDG PET/CT has the advantage of being a whole-body imaging modality and can recognize disease involvement prior to any anatomical changes.

Rosai-Dorfman Disease of the Right Atrium Revealed by FDG PET/CT

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is an uncommon histiocytic disorder, which is rare and typically occurs in lymph nodes. However, one third of the cases manifest as extranodal disease. The cardiac involvement of this disease is extremely rare. We reported here the FDG PET/CT findings of a pathologically confirmed Rosai-Dorfman disease occurring in the right atrium in a 60-year-old man.

Rosai-Dorfman Disease-Utility of 18F-FDG PET/CT for Initial Evaluation and Follow-up

BACKGROUND

The role of imaging in the management of Rosai-Dorfman disease (RDD), a rare non-Langerhans cell histiocytosis, is not clearly defined. We present an analysis of FDG PET/CT findings obtained for initial disease characterization, follow-up evaluation, and treatment planning for this disease.

METHODS

From an institutional pathology database (2001-2018), we identified RDD patients who underwent FDG PET/CT scans either as part of clinical care or when done as part of clinical trials. For all scans, sites of abnormal FDG uptake were assessed, and SUVmax was measured. Comparison of PET/CT findings was made with anatomic (CT/MRI-based) imaging, where available. Instances of changing treatment based on PET/CT were recorded.

RESULTS

We reviewed 109 FDG PET/CT scans in 27 patients with RDD. Five of 27 patients had only nodal/cutaneous disease, whereas 22 patients had extranodal disease, most commonly in bone (n = 9) and central nervous system (n = 7). PET/CT identified sites of active disease in 24 of 27 patients. All identified bone and extraskeletal lesions, except for a brain lesion in 1 patient, were FDG-avid. In 6 of 20 patients (30%) with available prior CT or MRI, PET/CT demonstrated additional RDD lesions (bones: n = 5, pleura: n = 1) that were not apparent on anatomic imaging; 3 of these lesions were outside the CT field of view, and 3 were not recognized on CT. Overall, 13 of 109 PET/CT scans led to a change in management, affecting 41% (11/27) of patients.

CONCLUSION

FDG PET/CT was valuable in defining disease extent and optimizing treatment strategy in patients with RDD.

Rosai-Dorfman Disease Presenting as a Pulmonary Artery Mass on FDG PET/CT

Rosai-Dorfman disease (RDD) is an uncommon histiocytic disorder typically involving the lymph nodes and occasionally manifests as extranodal disease. Extranodal RDD involving pulmonary artery without lymphadenopathy or other extranodal lesions is very rare. We present the case of a 48-year-old woman complaining of shortness of breath on exertion for 6 months. F-FDG PET/CT revealed a pulmonary artery mass with intense FDG avidity. No other abnormal FDG-avid lesion was observed. The pulmonary artery mass was then surgically removed, and the pathological and immunohistochemical results confirmed RDD.

Preparation and Logistic Considerations in Performing PET and PET/Computed Tomography in Pediatric Patients

It is good for the nuclear medicine technologist to be aware of the normal variants and the appearance of a good-quality scan. The primary responsibility as a nuclear medicine technologist is to provide an optimal quality scan that maximizes the reading physician's ability to correctly interpret while using current radiation safety practices as the best possible experience is created for patients and families. Combining the radiation safety aspects (nuclear) with how care is provided (medicine) and the use of the most recent equipment (technology) is what defines a nuclear medicine technologist.