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Jiang Y, Lu Q, Lou C, Huang Z. Primary Hepatic Gastrointestinal Stromal Tumor on 18F-FDG PET/CT Images. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00571. [PMID: 37220247 DOI: 10.1097/rlu.0000000000004723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
ABSTRACT Primary hepatic gastrointestinal stromal tumor is an extremely rare type of liver tumor with an unknown origin and poor prognosis and usually lacking specific symptoms. This makes it difficult to make an accurate diagnosis. We report the case of a 56-year-old man with primary hepatic gastrointestinal stromal tumor demonstrating multiple heterogeneous lesions with intense FDG uptake in the liver on PET/CT mimicking hepatocellular carcinoma or sarcoma. Primary hepatic gastrointestinal stromal tumor should be considered among the differential diagnoses when multiple FDG-avid primary liver neoplasms are found in patients with malignant characteristic on PET/CT imaging.
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Affiliation(s)
- Yang Jiang
- From the Department of Nuclear Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Qingqing Lu
- Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cen Lou
- From the Department of Nuclear Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Zhongke Huang
- From the Department of Nuclear Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
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Xiao L, Wang Y, Li L. A Stromal Tumor Presenting as a Pseudoaneurysmal Dilation of the Small Bowel Mimicking a Lymphoma on FDG PET/CT. Clin Nucl Med 2022; 47:e83-e84. [PMID: 34284473 DOI: 10.1097/rlu.0000000000003832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACT An 84-year-old woman visited our hospital with hematochezia for 1 month. Abdominal CT and FDG PET/CT showed local thickening of the small intestine, resembling an intestinal aneurysmal dilatation. Thus, a lymphoma was suspected, and surgical resection was performed. The final pathology revealed an exophytic small bowel stromal tumor with perforation, causing pseudoaneurysmal dilation of the small bowel. This case emphasized the importance of considering a small bowel stromal tumor when faced with similar FDG PET/CT findings.
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Affiliation(s)
- Liu Xiao
- From the Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Guo X, He H, Gao Q, Jin Y. Isolated Metastasis to Spleen-Stomach Space From Follicular Thyroid Cancer Combined With a Benign Subcutaneous Nodule on 18F-FDG PET/CT and 131I Scintigraphy. Clin Nucl Med 2021; 46:e156-e158. [PMID: 32910059 DOI: 10.1097/rlu.0000000000003241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 40-year-old woman with follicular thyroid cancer underwent a systemic PET/CT evaluation before operation and then received total thyroidectomy and radioactive 131I ablation therapy. Posttreatment imaging of 131I whole-body scan with SPECT/CT showed that metastasis on the spleen-stomach space coexists with mimicking subcutaneous metastasis, considering their level of 131I accumulation and morphological changes on PET/CT. However, histopathology confirmed the subcutaneous lesion of fibrous hyperplasia by fine-needle aspiration. This case demonstrates a vital role of SPECT/CT in the diagnosis of metastatic thyroid cancer and mimicking metastasis.
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Affiliation(s)
- Xiuyu Guo
- From the Department of Radiology and Ningbo PET/CT Center, Hwa Mei Hospital, University of Chinese Academy of Sciences
| | - Hua He
- From the Department of Radiology and Ningbo PET/CT Center, Hwa Mei Hospital, University of Chinese Academy of Sciences
| | - Qiaolin Gao
- From the Department of Radiology and Ningbo PET/CT Center, Hwa Mei Hospital, University of Chinese Academy of Sciences
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Esophageal insufflation computed tomography for the diagnosis and management of esophageal submucosal tumors. Surg Endosc 2016; 31:2350-2355. [PMID: 27631315 DOI: 10.1007/s00464-016-5220-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The selection of therapy for benign esophageal lesions depends in part on whether the lesion extends to or through the esophageal muscle wall. The advent of endoscopic dissection of deep lesions has made this distinction important in the choice between different forms of advanced endoscopic therapy. The goal of this study was to evaluate esophageal insufflation computed tomography (EICT) for the diagnosis and management of esophageal submucosal tumors (SMTs). METHODS Between April 2011 and May 2013 at the Second Affiliated Hospital of Harbin Medical University, 27 patients with esophageal SMTs diagnosed by gastroscopy were studied observationally. Entry criteria included tumors larger than 0.5 cm. We compared endoscopic ultrasound (EUS) and EICT to assess lesion depth and the relationship between the submucosal lesion and the esophageal wall using the resected lesion as the gold standard. RESULTS Twenty-seven esophageal SMTs were evaluated. EUS and EICT accurately identified nine as superficial to the muscularis propria. EICT correctly identified the relation of the tumor extension and the outer esophageal wall in all 18 lesions that originated from the muscularis propria; only nine were correctly assessed by EUS (P < 0.001). CONCLUSIONS EICT enables improved judgment of the relation of esophageal lesions and the esophageal-mediastinal border. We propose EICT as a new, safe, effective, useful, simple and high-tolerance method for assessing the depth and relationships of esophageal submucosal lesions.
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Shinagare AB, Ip IK, Lacson R, Ramaiya NH, George S, Khorasani R. Gastrointestinal Stromal Tumor: Optimizing the Use of Cross-sectional Chest Imaging during Follow-up. Radiology 2015; 274:395-404. [DOI: 10.1148/radiol.14132456] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gastrointestinal stromal tumour with unusual sites of metastasis: Accurate staging with 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mukherjee A, Karunanithi S, Singla S, Bal C, Kumar R. Gastrointestinal stromal tumour with unusual sites of metastasis: accurate staging with ¹⁸F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2014; 34:60-1. [PMID: 25263720 DOI: 10.1016/j.remn.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Anirban Mukherjee
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sellam Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Suhas Singla
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
PURPOSE The aim of this study was to evaluate F-FDG PET/CT findings of malignant nonepithelial prostate tumors and their correlation with MRI and CT images. PATIENTS AND METHODS FDG PET/CT findings were reviewed in 12 patients with malignant nonepithelial prostate tumor confirmed by pathology. The location, size, SUVmax, pathologic findings, and available MRI and CT images of the tumors were reviewed. RESULTS Of the 12 patients (mean age, 41 years; age range, 19-66 years), 9 had normal prostate-specific antigen levels. The mean size of the tumors was 7.1 cm in diameter ranging from 4.6 to 10.5 cm. All the tumors showed increased metabolic activity with mean SUVmax of 17.5 ranging from 3.6 to 46.8. The high-grade malignant tumors tended to show higher FDG uptake, whereas the intermediate-grade and low-grade malignant ones tended to show lower FDG uptake. Seven tumors had local invasion or distant metastases. Lung was the most common metastatic site. On MRI, the tumors showed well-circumscribed or ill-circumscribed margins with inhomogeneous enhancement. On CT, the tumors showed hypodensity with slight to moderate enhancement. CONCLUSIONS The malignant nonepithelial prostate tumors tended to have large sizes at presentation, have high FDG uptake, and affect a younger population with normal prostate-specific antigen levels. FDG PET/CT may be useful for the assessment of tumor grade and for detecting the distant metastases, whereas the MRI or enhanced CT may be more helpful for describing the relationship between the tumor and adjacent structures.
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Kang J, Jeon TJ, Yoon SO, Lee KY, Sohn SK. An extragastrointestinal stromal tumor in the omentum with peritoneal seeding mimicking an appendiceal mucinous cancer with carcinomatosis. Ann Coloproctol 2014; 30:93-6. [PMID: 24851220 PMCID: PMC4022759 DOI: 10.3393/ac.2014.30.2.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 11/24/2013] [Indexed: 11/11/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. These tumors tend to present most frequently in the stomach, followed by the small intestine. GISTs can also arise from the omentum, retroperitoneum, mesentery, or pleura and are termed extragastrointestinal stromal tumors (EGISTs) when they do so. EGISTs arising from the omentum are very rare. Due to the limited incidence of EGISTs in the omentum, the diagnostic criteria are not well established, and making a correct diagnosis may be difficult. In this report, we present a case of an EGIST of the omentum with peritoneal metastasis that was initially suspected to be an appendiceal mucinous carcinoma with carcinomatosis on positron emission tomography/computed tomography imaging.
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Affiliation(s)
- Jeonghyun Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Och Yoon
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Kook Sohn
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Huang YQ. Advances in research of gastrointestinal stromal tumors. Shijie Huaren Xiaohua Zazhi 2014; 22:1633-1641. [DOI: 10.11569/wcjd.v22.i12.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, arising from the interstitial cells of Cajal (ICCs), primarily in the stomach and small intestine. The growth of most GISTs is driven by the mutations of genes encoding oncogenic receptor tyrosine kinase KIT or platelet derived growth factor receptor alpha (PDGFRα). The pathogenesis of GISTs may involve ICCs, microRNAs (miRNAs), signaling pathways, DNA methylation, and KIT or PDGFRα gene mutations. This article systematically describes the advances in research of GISTs in terms of clinical features, imaging characteristics, endoscopic features, histopathological features, diagnosis and therapies.
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Dong A, Bai Y, Wang Y, Zuo C, Lu J. Spectrum of the prostate lesions with increased FDG uptake on 18F-FDG PET/CT. ACTA ACUST UNITED AC 2014; 39:908-21. [DOI: 10.1007/s00261-014-0114-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Betz M, Kopp HG, Spira D, Claussen CD, Horger M. The benefit of using CT-perfusion imaging for reliable response monitoring in patients with gastrointestinal stromal tumor (GIST) undergoing treatment with novel targeted agents. Acta Radiol 2013; 54:711-21. [PMID: 23761542 DOI: 10.1177/0284185113484642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Solely size-based response criteria may be unreliable in patients with gastrointestinal stromal tumors (GIST) treated with tyrosine kinase inhibitors, because they typically underestimate responses to treatment. As GISTs are generally hypervascularized and novel targeted drugs knowingly affect angiogenic signaling pathways, perfusion measurements are expected to deliver important information about their efficacy. This pictorial essay illustrates the benefit of using complementary CT-perfusion-based measurements for more accurate evaluation of response to therapy in GIST.
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Affiliation(s)
- Martina Betz
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - Hans Georg Kopp
- Department of Oncology, Hematology, Rheumatology, Immunolgy, Pulmology, Eberhard-Karls-University, Tübingen, Germany
| | - Daniel Spira
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - Claus D Claussen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen
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Hu QX, Gao Q. Clinical features and treatment of gastrointestinal stromal tumors: Recent advances. Shijie Huaren Xiaohua Zazhi 2012; 20:2050-2057. [DOI: 10.11569/wcjd.v20.i22.2050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common gastrointestinal mesenchymal tumors. The development of molecular biology, pathology and clinical medicine in recent years has deepened our understanding of GISTs. The combination of traditional surgery and molecular targeted drugs is particularly important for the treatment of GISTs. Multi-target and multi-kinase inhibitors such as imatinib and sunitinib have been used for the treatment of unresectable and recurrent GISTs. This paper provides a brief review of gene analysis, pathological characteristics, operational and adjuvant therapy of GISTs.
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Shinagare AB, Zukotynski KA, Krajewski KM, Jagannathan JP, Butrynski J, Hornick JL, Ramaiya NH. Esophageal gastrointestinal stromal tumor: report of 7 patients. Cancer Imaging 2012; 12:100-8. [PMID: 22542728 PMCID: PMC3362870 DOI: 10.1102/1470-7330.2012.0017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Purpose: To evaluate imaging features of esophageal gastrointestinal stromal tumors (GIST) with clinical and histopathologic correlation and imaging follow-up. Materials and methods: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, 14 patients with pathologically proven esophageal GIST seen from January 2001 to October 2011, 7 patients (4 women; mean age 70 years, range 56–87 years) who had imaging of primary tumor and follow-up imaging at our institution were included. Imaging studies were evaluated by 3 radiologists in consensus. Location, size and imaging features of primary tumor and metastases, if any, were recorded, and correlated with pathologic (histopathologic subtype, presence of necrosis, mitotic rate, immunohistochemical profile) and clinical (treatment-related changes, distant spread and outcome) parameters. Results: Of 7 tumors, 5 were located in the lower esophagus and 2 in mid-esophagus. Four were intraluminal, 2 were exophytic, and 1 was intramural. All 7 patients underwent computed tomography (CT); tumors appeared as well-circumscribed, hypoattenuating masses showing mild enhancement, with mean size of 5.7 × 4.2 cm. Necrosis and calcification were seen in 1 tumor each. Five patients underwent fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. GISTs were FDG avid with mean standardized uptake value (SUV)max of 9.5 (4.5–12.3). All tumors were positive for KIT (7/7) and CD34 (6/6). Distant metastases to liver and pleura were seen in 1 patient. On imatinib treatment, the tumors responded with decreased attenuation values and unchanged size on CT, and decreased SUVmax of primary tumor and metastases on FDG-PET/CT. Conclusion: Esophageal GISTs are well-circumscribed, FDG-avid, hypoattenuating masses that can metastasize to liver and pleura, and respond to imatinib treatment with decreased attenuation value on CT and decreased SUVmax on FDG-PET/CT.
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Affiliation(s)
- A B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA.
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Abstract
This case demonstrates extraosseous 99m-technetium methylene diphosphonate (Tc-99m MDP) accumulation from a gastrointestinal stromal tumor. A 75-year-old woman underwent a temporal bone CT for conductive hearing loss that showed sclerosis in the right occipital condyle. Follow-up Tc-99m MDP bone scan for osseous metastases instead showed a mass-like extraosseous accumulation of Tc-99m MDP in the anterior left upper quadrant. Differential diagnoses included gastric cancer, lymphoma, metastatic melanoma, systemic hypercalcemia, or heterotopic mesenteric ossification. Contrast CT showed a well-circumscribed mass arising from the stomach, and subsequent pathology confirmed gastrointestinal stromal tumor. These tumors rarely can contain osteoclast-like giant cells and should be considered for extraosseous Tc-99m MDP accumulation.
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