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Padoan R, Campaniello D, Gatto M, Schiavon F, Doria A. Current clinical and therapeutic approach to tumour-like mass lesions in granulomatosis with polyangiitis. Autoimmun Rev 2021; 21:103018. [PMID: 34902605 DOI: 10.1016/j.autrev.2021.103018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic autoimmune disorder classified among the anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and characterized by a triad of upper and lower respiratory tract disease, systemic vasculitis involving small-to-medium vessels and renal manifestations. Mass lesions, also described as inflammatory lesions, pseudotumor or tumour-like masses, are uncommon manifestations of GPA and are often called granuloma since histology examination shows granulomatous inflammation and rarely vasculitis. Masses could represent a localized manifestation of GPA or develop as part of a systemic disease. Unusual clinical presentation together with nonspecific radiological and histological features may delay the correct diagnosis leading to disease progression and organ damage. Diagnosis of GPA in such cases may be challenging and malignancy or infections must be considered as alternative diagnostic options. Here we reviewed all the different sites where mass lesions were reported in GPA, focusing on atypical localization, and summarized current therapeutic options and their different outcomes. We retrieved and discussed the cases reported since 2010, bearing in mind the advances in the therapeutic management of AAV patients in the last decade, namely biological therapy such as rituximab. Despite treatment regimens with glucocorticoids and immunosuppressive agents, mass lesions have a refractory course in a high proportion of patients. Invasive surgical procedures may be considered only when drug therapy fails.
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Affiliation(s)
- Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Debora Campaniello
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Mariele Gatto
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Franco Schiavon
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Italy.
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Akiyama M, Takanashi S, Takeuchi T, Kaneko Y. Salivary gland involvement in ANCA-associated vasculitis. Autoimmun Rev 2021; 20:102940. [PMID: 34509652 DOI: 10.1016/j.autrev.2021.102940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Salivary gland involvement in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis is rare, but can lead to the misdiagnosis of other diseases. The objective of this study was to clarify the characteristics of patients with salivary gland involvement. METHODS We conducted a systematic literature review of articles reporting salivary gland involvement in ANCA-associated vasculitis from the inception dates until May 2, 2021. RESULTS We identified 58 patients with salivary gland involvement. The mean age was 52 years, and men were predominantly affected (59%). Half of the patients presented with fever. Swelling of the salivary gland was the initial manifestation in 88% of the patients, unilaterally affected in 53%, and painful in 47%. The affected salivary glands were as follows: parotid gland alone (53%), submandibular gland alone (33%), and both parotid and submandibular glands (14%). Additionally, two patients had sublingual gland involvement. The most frequent clinical diagnosis was granulomatosis with polyangiitis (83%), followed by eosinophilic granulomatosis with polyangiitis (17%), while no patient was diagnosed with microscopic polyangiitis. PR3-ANCA positivity (72%) was predominant to MPO-ANCA positivity (6%), and ANCA was negative in 22% of the patients. Among 37 ANCA-positive patients, 6 patients (16%) were initially ANCA-negative, but subsequently became positive during the clinical course. The serum C-reactive protein levels were elevated in all the examined patients. On contrast-enhanced computed tomography, a finding suggestive of necrosis, which was heterogeneous enhancement with low-density areas, was found in 33% of the patients. Vasculitis, granulomatous inflammation, necrosis, or the presence of multinucleated giant cells was found in 83% of the biopsy samples of the affected salivary gland. Glucocorticoids with or without other immunosuppressive agents, such as cyclophosphamide were effective in most patients, but twelve patients (21%) experienced a relapse of the disease and nine patients (16%) died during the clinical course. CONCLUSION Salivary gland involvement can be an initial manifestation of ANCA-associated vasculitis. The recognition of this unusual atypical presentation is important for the early and accurate diagnosis and treatment.
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Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Satoshi Takanashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Japan.
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Alp A, Akdam H, Barutça S, Meydan N, Yeniçerioğlu Y, Meteoglu I, Şentürk T. Pulmonary nodules with crescentic glomerulonephritis. Is it always anti-neutrophil cytoplasmic antibody associated? GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04152-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Abdelghany MF, Khalaf MGA. Submandibular salivary gland involvement in granulomatosis with polyangiitis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_15_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Saleh Farghaly HR, Alqarni AO, Nasr HA. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Assessment of Occult Involvement in Widespread Granulomatosis with Polyangiitis (Wegener's Granulomatosis). Indian J Nucl Med 2019; 34:153-156. [PMID: 31040531 PMCID: PMC6481197 DOI: 10.4103/ijnm.ijnm_151_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) can be classified as classic triad of organ involvement consisting of lungs, upper respiratory tract/sinuses, and kidneys; limited which is not having the full triad; or widespread with additional organ involvement for example prostate, spleen, skin, eyes or peripheral nervous system and occasionally other organs. GPA is associated with increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT). PET/CT has the advantages of whole-body imaging and detecting metabolic abnormality before structural changes. FDG PET/CT is used to assess the extent of the disease in GPA and can detect site of occult disease involvement where there are metabolic evidence of defined organ involvement with no CT or clinical evidence. This may result in upgrading of the disease from limited to classic triad or from classic triad to widespread.
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Affiliation(s)
- Hussein Rabie Saleh Farghaly
- Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdullah Othman Alqarni
- Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hatem Ahmed Nasr
- Department of Radiology, Division of Nuclear Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Department of Oncology and Nuclear Medicine, Nuclear Medicine Unit, Kasr Al-Aini-Cairo University Hospital, Cairo, Egypt
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Schmidt WA, Blockmans D. Investigations in systemic vasculitis - The role of imaging. Best Pract Res Clin Rheumatol 2018; 32:63-82. [PMID: 30526899 DOI: 10.1016/j.berh.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 12/18/2022]
Abstract
Imaging plays an increasing role for confirming a suspected diagnosis of giant cell arteritis (GCA) or Takayasu arteritis (TAK). Ultrasound, magnetic resonance imaging (MRI), and computed tomography demonstrate a homogeneous, most commonly concentric, arterial wall thickening. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) displays increased FDG uptake of inflamed artery walls delineating increased metabolism. Ultrasound and MRI are recommended to be the initial imaging modalities in cranial GCA and TAK, respectively. Extracranial disease can be confirmed by all four modalities, particularly by PET in case of inflammation of unknown origin. If the diagnosis remains uncertain, additional investigations including biopsy and/or additional imaging are recommended. Imaging should be performed by a trained specialist using appropriate operational procedures and settings with appropriate equipment. Further research is necessary on the role of imaging for disease monitoring. This review will discuss advantages and disadvantages of imaging modalities in the diagnosis of vasculitis.
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Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125, Berlin, Germany.
| | - Daniel Blockmans
- University Hospital Gasthuisberg, Herestraat 49, B3000, Leuven, Belgium.
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18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography for the Diagnosis of Large Vessel Vasculitis Associated With Malignancy: A Case of Large Vessel Vasculitis Associated With Neuroendocrine Carcinoma of the Duodenum. J Clin Rheumatol 2018; 25:e98-e101. [PMID: 30211756 DOI: 10.1097/rhu.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Frary EC, Hess S, Gerke O, Laustrup H. 18F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography can reliably rule-out infection and cancer in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis suspected of disease relapse. Medicine (Baltimore) 2017; 96:e7613. [PMID: 28746217 PMCID: PMC5627843 DOI: 10.1097/md.0000000000007613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune diseases characterized by systemic inflammation in small- to medium-sized blood vessels. Although immunosuppressive therapy has greatly improved the prognosis for these patients, there are still significant comorbidities, such as cancer and infection, associated with AAV. These comorbidities are often indistinguishable from an underlying AAV disease relapse, and create a clinical conundrum, as these conditions are normally contraindications for immunosuppressive treatment. Thus, it is important to be able to rule out these comorbidities before initiation of immunosuppressive treatment. We examined F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography (FDG-PET/CT)'s value in ruling out cancer or infection in patients with AAV.Data were obtained retrospectively for a clinically based cohort of AAV patients who underwent FDG-PET/CT during 2009 to 2014 owing to a suspicion of cancer, infection, or both cancer and infection indistinguishable from disease relapse. FDG-PET/CT conclusions were compared to the final diagnoses after follow-up analysis (mean 43 months).A total of 19 patients were included who underwent a total of 26 scans. The results of FDG-PET/CT outcome compared to final diagnosis were: 9 true positives, 3 false positives, 13 true negatives, and 1 false negative. The diagnostic probabilities for FDG-PET/CT with respect to overall comorbidity (i.e., cancer or infection) were: sensitivity 90% ( 95% confidence interval [CI] 60%-98%), specificity 81% ( 95% CI 57%-93%), positive predictive value 75% (95% CI 47%-91%), negative predictive value 93% (95% CI 68%-99%), and accuracy 84% (95% CI 66%-94%).FDG-PET/CT had a high negative predictive value and ruled out the comorbidities correctly in all but one case of urinary tract infection, a well-known limitation. Our study showed FGD-PET/CT's promise as an effective tool for ruling out cancer or infection in patients with AAV albeit in a limited population.
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Affiliation(s)
- Evan C. Frary
- Department of Nuclear Medicine, Odense University Hospital, Odense C
| | - Søren Hess
- Department of Nuclear Medicine, Odense University Hospital, Odense C
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense C
- Center of Health Economics Research, University of Southern Denmark, Odense M
| | - Helle Laustrup
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C
- Department of Rheumatology, Odense University Hospital, Odense C, Denmark
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Duncan JR, Carr D, Kaffenberger BH. The utility of positron emission tomography with and without computed tomography in patients with nonmelanoma skin cancer. J Am Acad Dermatol 2016; 75:186-96. [PMID: 26992283 DOI: 10.1016/j.jaad.2016.01.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Combined positron emission tomography (PET) and computed tomography (CT) scans are widely used in the staging and monitoring of most malignancies. The differential for PET-positive cutaneous lesions includes primary skin cancers, infections, cutaneous metastases from distant malignancies, and benign neoplasms. In dermatology, PET/CT scans have been most widely studied in patients with melanoma and Merkel cell carcinoma. The role of PET/CT scans in the management of other cutaneous malignancies is less clear, but it has shown great promise in the management of patients with squamous cell carcinoma and cutaneous lymphoma. This review seeks to address the usefulness of PET/CT scans in nonmelanoma skin cancer and to provide guidance regarding the management of patients with incidental PET-positive nodules. Currently, there is limited experience with PET/CT scans for staging and monitoring of non-head and neck metastatic basal cell and squamous cell carcinomas, and results show limited sensitivity and specificity. We also address the evidence for management of an incidental PET-positive cutaneous nodule and recommend obtaining a biopsy specimen in patients with a known noncutaneous malignancy, a history of primary skin cancer, or a high risk of either cutaneous or noncutaneous malignancy.
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Affiliation(s)
| | - David Carr
- Division of Dermatology, Wexner Medical Center at Ohio State University, Ghanna, Ohio
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10
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Clinical significance of parotid gland incidentalomas on (18)F-FDG PET/CT. Clin Imaging 2015; 39:667-71. [PMID: 25888252 DOI: 10.1016/j.clinimag.2015.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/21/2015] [Accepted: 03/31/2015] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate the frequency and clinical significance of incidental focal uptake of (18)F-fluorodeoxyglucose (FDG) on positron emission tomography/computed tomography (PET/CT) in the parotid glands of cancer patients. A retrospective review of 7,252 oncologic PET/CT studies was done. FDG positive parotid incidentalomas occurred in 0.4% of PET/CT scans, of which only 4% were malignant. PET/CT was unable to differentiate benign from malignant parotid lesions based on SUVmax alone. (18)F-FDG positive parotid incidentalomas can be managed conservatively, however patients with a prior history of lymphoma had a much higher risk of parotid malignancy and require further investigation.
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11
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Granulomatosis with Polyangiitis Presenting as a Parotid Gland Abscess. Case Rep Med 2015; 2015:865108. [PMID: 25815014 PMCID: PMC4359816 DOI: 10.1155/2015/865108] [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: 10/08/2014] [Accepted: 01/28/2015] [Indexed: 11/17/2022] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a small-vessel vasculitis consisting of necrotizing granulomatous lesions in airways and focal necrotizing glomerulonephritis. However, it may affect other sites such as the skin, central nervous system, eyes, heart, gastrointestinal tract, and liver. We describe a rare case of GPA in which the initial manifestation was the involvement of the parotid gland mimicking a pyogenic abscess.
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12
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Ito K, Minamimoto R, Yamashita H, Morooka M, Okasaki M, Mimori A, Kubota K. 18F-FDG PET/CT findings preceded elevation of serum proteinase 3 antineutrophil cytoplasmic antibodies in Wegener granulomatosis. Clin Nucl Med 2014; 39:e67-8. [PMID: 23579980 DOI: 10.1097/rlu.0b013e3182817a95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 67-year-old woman underwent F-FDG PET/CT after developing a fever of unknown origin. PET/CT revealed intensive FDG uptake at the nasal and lung lesions. On the laboratory data, serum myeloperoxidase antineutrophil cytoplasmic antibodies (ANCA) titer was elevated, although serum directed against proteinase 3 (PR3) ANCA titer was within normal limits. One month after treatment, follow-up PET/CT revealed decreased FDG uptake at the lesions. One year later, serum PR3-ANCA titer elevated, which finally led to a diagnosis of Wegener granulomatosis (WG). WG lesions may be detected earlier by FDG PET/CT than by serum PR3-ANCA titers.
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Affiliation(s)
- Kimiteru Ito
- From the *Department of Radiology, National Center of Neurology and Psychiatry, †Division of Nuclear Medicine, National Center for Global Health and Medicine, and ‡Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
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An Unusual Orbital Localization of Wegener Granulomatosis Detected by 18F-FDG PET/CT. Clin Nucl Med 2014; 39:711-2. [DOI: 10.1097/rlu.0b013e31829b9e82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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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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15
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Horiguchi Y, Tsurikisawa N, Harasawa A, Oshikata C, Morita Y, Saitoh H, Saito I, Akiyama K. Detection of pulmonary involvement in eosinophilic granulomatosis with polyangiitis (Churg-Strauss, EGPA) with 18F-fluorodeoxyglucose positron emission tomography. Allergol Int 2014; 63:121-3. [PMID: 24270221 DOI: 10.2332/allergolint.13-le-0550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yoriko Horiguchi
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Naomi Tsurikisawa
- Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Arimi Harasawa
- Department of Radiology, Musashimurayama Hospital, Tokyo, Japan
| | - Chiyako Oshikata
- Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yukiko Morita
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Hiroshi Saitoh
- Clinical Research Centre for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Ikuo Saito
- Department of Pathology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Kazuo Akiyama
- Clinical Research Centre for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
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Soussan M, Abisror N, Abad S, Nunes H, Terrier B, Pop G, Eder V, Valeyre D, Sberro-Soussan R, Guillevin L, Dhote R, Fain O, Mekinian A. FDG-PET/CT in patients with ANCA-associated vasculitis: Case-series and literature review. Autoimmun Rev 2014; 13:125-31. [DOI: 10.1016/j.autrev.2013.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/25/2013] [Indexed: 12/21/2022]
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Aydin M, Akkoyunlu M, Yakar F, Ergul N, Sezer M. Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2013.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Intense FDG uptake on PET/CT in the upper and lower respiratory system indicative of Wegener's granulomatosis. Rev Esp Med Nucl Imagen Mol 2013; 33:32-5. [PMID: 23680478 DOI: 10.1016/j.remn.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022]
Abstract
Wegener's granulomatosis (WG) is an uncommon systemic vasculitis, which involves the upper and lower respiratory tracts and the kidneys. Because the patients generally present with clinical manifestations that are similar to common diseases, WG may be initially misdiagnosed as infection or malignancy. We report the case of a 55-year-old male presenting with weight loss, cough, hemoptysis, low-grade fever, and pulmonary nodules detected on the thoracic CT scan. Malignancy was initially suspected, so a PET/CT was performed. It demonstrated intense FDG uptake in the upper and lower respiratory system. The diagnosis of WG was based on PET findings, elevated serum levels of inflammatory markers, and the presence of c-ANCA. We consider that the knowledge of FDG-PET/CT findings may help to make an easier and earlier diagnosis of WG.
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Abstract
We report a case of a nodular nongranulomatous vasculitis of the lung detected by (18)F-FDG PET/CT. A 51-year-old woman with fever of unknown origin underwent (18)F-FDG PET/CT, which showed multiple and bilateral pulmonary nodules at CT scan with increased radiopharmaceutical uptake in the largest one (20 mm in diameter). On the basis of the PET/CT findings, the patient was referred for excisional biopsy of the largest pulmonary nodules suspicious for neoplastic disease. Histological examination demonstrated the presence of an obliterative vasculitis with interstitial pulmonary perivascular inflammation.
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Park JH, Lee YH, Ji JD, Song GG, Lee SW, Yoo SH, Ryu JY, Kim HR, Kang KH, Kang SH, Kim SW, Choi SJ. A Case of Wegener's Granulomatosis with Central Nervous System Involvement Mimicking Lung Cancer with Brain Metastasis. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Joo Hee Park
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jong Dae Ji
- Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Soon Wook Lee
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seu Hee Yoo
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ja Young Ryu
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hae Rim Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Keun Hee Kang
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sun Wha Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
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Ito K, Minamimoto R, Yamashita H, Yoshida S, Morooka M, Okasaki M, Mimori A, Kubota K. Evaluation of Wegener's granulomatosis using 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Ann Nucl Med 2012; 27:209-16. [PMID: 23242952 PMCID: PMC3618408 DOI: 10.1007/s12149-012-0675-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/04/2012] [Indexed: 12/21/2022]
Abstract
Objective Wegener’s granulomatosis (WG) is a relatively rare disease characterized by granulomatous necrotizing vasculitis that primarily involves small- and medium-sized vessels. Systemic findings observed on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) have not been well reported. The purpose of this study was to evaluate the FDG PET/CT imaging in the diagnosis and follow-up of patients with WG. Materials and methods Thirteen FDG PET/CT images obtained for 8 patients (2 men and 6 women) with WG were retrospectively analyzed. Of these, 6 were performed for diagnosis, 2 for restaging and follow-up, and 5 for assessment of treatment efficacy. Maximum standardized uptake values (max SUVs) and visual analyses were used to interpret the FDG PET/CT images. In addition, nonenhanced CT findings obtained during FDG PET/CT were described. Results WG lesions of the upper respiratory tract and lung were more clearly detected by FDG PET/CT fusion imaging than by nonenhanced CT alone, and all of the active lesions showed decreased FDG uptake after treatment. In addition, FDG PET/CT can provide complementary information to indicate biopsy site based on FDG uptakes. Conclusions FDG PET/CT is a feasible modality for evaluating lesion activities, therapeutic monitoring, and follow-up of WG. Furthermore, biopsy sites of WG lesions may be determined by FDG PET/CT.
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Affiliation(s)
- Kimiteru Ito
- Department of Radiology, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
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