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Ando M, Mukai Y, Ushijima RI, Shioyama Y, Umeki K, Okada F, Nureki SI, Mimata H, Kadota JI. Disseminated Mycobacterium tuberculosis Infection Masquerading as Metastasis after Heavy Ion Radiotherapy for Prostate Cancer. Intern Med 2016; 55:3387-3392. [PMID: 27853089 PMCID: PMC5173514 DOI: 10.2169/internalmedicine.55.7039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fluorodeoxyglucose (FDG)-positron emission tomography with computed tomography (FDG-PET/CT) is useful in disease monitoring of malignancies after therapy, while an FDG uptake may also be present in benign diseases. We herein demonstrate a case of disseminated Mycobacterium tuberculosis mimicking systemic metastasis of prostate cancer. This case highlights that clinicians should consider Mycobacterium tuberculosis in patients with prostate cancer who demonstrate multifocal FDG uptakes masquerading as metastasis, even when the chest photographs reveal a normal appearance and a sputum examination demonstrates negative results. An invasive surgical biopsy may be required and a pathological analysis would be critical in the diagnosis of Mycobacterium tuberculosis.
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Affiliation(s)
- Masaru Ando
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
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Yamada S, Ueki K, Kawai Y, Sako T, Shimomura Y, Tsuchimoto A, Tanaka S, Matsui R, Maeda H, Tokumoto M, Ooboshi H, Kitazono T, Tsuruya K. Extrapulmonary tuberculosis presented as fever of unknown origin in two patients with endstage kidney disease not on dialysis: usefulness of 18-FDG-PET/CT in the diagnostic localization of fever of unknown origin. CEN Case Rep 2015; 5:11-17. [PMID: 28509157 DOI: 10.1007/s13730-015-0181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/06/2015] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis is one of the common causes of fever of unknown origin in patients with chronic kidney disease (CKD). Extrapulmonary tuberculosis is more common in CKD patients, and is, unfortunately, often underdiagnosed despite extensive assessments. Recently, fluorine-18-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has been available in the diagnosis of malignancy, inflammatory and infectious diseases, and has become a useful diagnostic tool. Here, we present two cases of endstage kidney disease who presented with fever of unknown origin at the time of dialysis initiation. In both cases, although interferon-gamma-releasing assay was positive, combined conventional diagnostic modalities such as computed tomography and gallium-citrate scintigraphy failed to detect the sites infected with tuberculosis. By contrast, extrapulmonary lesions were detected by FDG-PET/CT and successfully treated with combined anti-tuberculous drugs. Diagnosis of extrapulmonary tuberculosis was confirmed by biopsy of the affected lymph node and lumbar spine, followed by PCR of the biopsied specimen. These cases highlight the importance of considering tuberculosis as one of the differential diagnoses in pre-dialysis CKD patients with persistent fever, and the usefulness of FDG-PET/CT in the detection of infectious sites of extrapulmonary tuberculosis.
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Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Kenji Ueki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Kawai
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Teppei Sako
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukiko Shimomura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rei Matsui
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroto Maeda
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroaki Ooboshi
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Liu Y. Postoperative reactive lymphadenitis: A potential cause of false-positive FDG PET/CT. World J Radiol 2014; 6:890-894. [PMID: 25550993 PMCID: PMC4278149 DOI: 10.4329/wjr.v6.i12.890] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/01/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
A wide variety of surgical related uptake has been reported on F18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) scan, most of which can be differentiated from neoplastic process based on the pattern of FDG uptake and/or anatomic appearance on the integrated CT in image interpretation. A more potential problem we may be aware is postoperative reactive lymphadenitis, which may mimic regional nodal metastases on FDG PET/CT. This review presents five case examples demonstrating that postoperative reactive lymphadenitis could be a false-positive source for regional nodal metastasis on FDG PET/CT. Surgical oncologists and radiologists should be aware of reactive lymphadenitis in interpreting postoperative restaging FDG PET/CT scan when FDG avid lymphadenopathy is only seen in the lymphatic draining location from surgical site.
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Xanthogranulomatous osteomyelitis of rib mimicking malignant lesions in (18)F-FDG PET/CT imaging: a report of two cases. Clin Nucl Med 2014; 39:e315-7. [PMID: 24476637 DOI: 10.1097/rlu.0b013e3182a20d45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Xanthogranulomatous osteomyelitis is a rare inflammatory process characterized histologically by collection of foamy macrophages admixed with mononuclear cells. We describe 2 cases with chest and back pain; radiography and CT scan identified expansile osteolytic rib destructive lesions with soft tissue mass. F-FDG PET/CT revealed accumulation of F-FDG similar to malignancy. Xanthogranulomatous osteomyelitis was histologically confirmed with numerous foamy histiocytes admixed with inflammatory infiltrate.
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Park WJ, Kim EK, Park JH. Extensive tuberculous lymphadenitis mimicking distant lymph node metastasis on F-18FDG PET/CT in a patient with a history of malignant melanoma. Yonsei Med J 2013; 54:1554-6. [PMID: 24142667 PMCID: PMC3809874 DOI: 10.3349/ymj.2013.54.6.1554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
18-Fluoredeoxyglucose position emission tomography and computed tomography (F-18FDG PET/CT) scanning has been useful in the evaluation of malignant disorders and has been extensively used in cancer screening. However, F-18FDG uptake was not found to be specific for cancer diagnosis. Here, we describe increased F-18FDG uptake on PET/CT caused by extensive tuberculous lymphadenitis in a 62-year-old woman with malignant melanoma.
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Affiliation(s)
- Woon-Ju Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Contractor K, Challapalli A, Tomasi G, Rosso L, Wasan H, Stebbing J, Kenny L, Mangar S, Riddle P, Palmieri C, Al-Nahhas A, Sharma R, Turkheimer F, Coombes RC, Aboagye E. Imaging of cellular proliferation in liver metastasis by [18F]fluorothymidine positron emission tomography: effect of therapy. Phys Med Biol 2012; 57:3419-33. [PMID: 22572708 DOI: 10.1088/0031-9155/57/11/3419] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although [(18)F]fluorothymidine positron emission tomography (FLT-PET) permits estimation of tumor thymidine kinase-1 expression, and thus, cell proliferation, high physiological uptake of tracer in liver tissue can limit its utility. We evaluated FLT-PET combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (FLT-PET(KSF)) for detecting drug response in liver metastases. FLT-PET and computed tomography data were collected from patients with confirmed breast or colorectal liver metastases before, and two weeks after the first cycle of chemotherapy. Changes in tumor FLT-PET and FLT-PET(KSF) variables were determined. Visual distinction between tumor and normal liver was seen in FLT-PET(KSF) images. Of the 33 metastases from 20 patients studied, 26 were visible after kinetic filtering. The net irreversible retention of the tracer (Ki; from unfiltered data) in the tumor, correlated strongly with tracer uptake when the imaging variable was an unfiltered average or maximal standardized uptake value, 60 min post-injection (SUV(60,av): r = 0.9, SUV(60,max): r = 0.7; p < 0.0001 for both) and occurrence of high intensity voxels derived from FLT-PET(KSF) (r = 0.7, p < 0.0001). Overall, a significant reduction in the imaging variables was seen in responders compared to non-responders; however, the two week time point selected for imaging was too early to allow prediction of long term clinical benefit from chemotherapy. FLT-PET and FLT-PET(KSF) detected changes in proliferation in liver metastases.
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Lee JW, Lee SM, Choi JH. (18)F-FDG PET/CT Findings in a Breast Cancer Patient with Concomitant Tuberculous Axillary Lymphadenitis. Nucl Med Mol Imaging 2011; 45:152-5. [PMID: 24899996 DOI: 10.1007/s13139-011-0080-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/17/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022] Open
Abstract
Although (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) is a sensitive modality for detecting a malignant lesion, increased (18)F-FDG uptake is also seen in infected or inflammatory processes. Here, we report the case of a breast cancer patient with concomitant tuberculous axillary lymphadenitis that showed increased (18)F-FDG uptake. A 39-year-old woman underwent preoperative (18)F-FDG PET/computed tomography (CT) as a part of the work-up for right breast cancer. (18)F-FDG PET/CT images showed a malignant lesion in the right breast with moderate (18)F-FDG uptake, and multiple enlarged right axillary lymph nodes with intense (18)F-FDG uptake. Subsequently, the patient underwent right mastectomy and right axillary lymph node dissection. Histopathological examination confirmed breast cancer and tuberculous lymphadenitis, and the patient was treated concomitantly with anti-tuberculous therapy.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, Jeju National University Hospital, 66 Jeju-Daehakno, Jeju-si, Jeju Korea 690-767
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae Hyuck Choi
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
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Hong JY, Jung JY, Kang YA, Park BH, Jung WJ, Lee SH, Kim SY, Lee SK, Chung KS, Park SC, Kim EY, Lim JE, Kim SK, Chang J, Kim YS. Utility of Routine Culture for Tuberculosis from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in a Tuberculosis Endemic Country. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.71.6.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Young Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ae Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hoon Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Hwan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kook Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Soo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Seon Cheol Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Eun Lim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Se Kyu Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
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Fujii T, Tabe Y, Yajima R, Tsutsumi S, Asao T, Kuwano H. Adenocarcinoma of Ascending Colon Associated with Sarcoid Reaction in Regional Lymph Nodes. Case Rep Gastroenterol 2010; 4:118-123. [PMID: 21103238 PMCID: PMC2988908 DOI: 10.1159/000275064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Lymph node swelling in the setting of malignancy generally suggests metastasis of the primary tumor. A granulomatous reaction, i.e. sarcoid reaction, occurring within the lymph nodes draining carcinomas is a well-known but uncommon occurrence. The phenomenon is especially rarely seen in colon carcinoma. We herein report a rare case of a 56-year-old Japanese male with adenocarcinoma of the ascending colon associated with sarcoid reaction in the regional lymph nodes. A typical ileocecal resection and lymph node dissection were performed. Histopathological examination revealed moderately differentiated adenocarcinoma of the ascending colon, and the dissected lymph nodes included epithelioid granulomas with multinucleated giant cells. These findings suggest the existence of a sarcoid reaction associated with colon carcinoma; there was no metastasis in the dissected lymph nodes. The significance of this rare condition is discussed.
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Affiliation(s)
- Takaaki Fujii
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Ito K, Morooka M, Kubota K. 18F-FDG PET/CT findings of pharyngeal tuberculosis. Ann Nucl Med 2010; 24:493-6. [PMID: 20238184 DOI: 10.1007/s12149-010-0368-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 02/22/2010] [Indexed: 11/25/2022]
Abstract
A 58-year-old woman with dysphagia and hoarseness underwent 18F-FDG PET/CT to detect the original lesion and disease spread. Bilateral cervical lymphadenopathy and abnormal FDG uptakes in the right tonsil and pharyngeal wall were demonstrated. CT and MRI confirmed the bilateral cervical lymphadenopathy and mucosal thickening in the pharyngeal wall. On the basis of these findings, biopsy sites were selected. Pharyngeal tuberculosis was diagnosed based on culture of the biopsy specimens. 18F-FDG PET/CT contributed to clinical management in this case by detecting tuberculous lesions and showing the extent of these lesions in one examination.
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Affiliation(s)
- Kimiteru Ito
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-3 Yamane, Hidaka, Saitama, Japan.
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