Unusual Delayed FDG-PET/CT Hypermetabolism Due to Charcoal-Induced Granuloma

Rahier, Quentin; Deprez, F C

doi:10.5334/jbsr.1549

Cited by 2 publications

(3 citation statements)

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“…Previous studies have reported that charcoal granulomas have irregular hypoechoic masses, with spiculated margins or posterior acoustic shadowing, like that in breast cancer [17][18][19]. Some lesions show increased FDG uptake on the FDG-PET CT scan, suggesting a malignancy [25][26][27]. There are many reports of other types of foreign-body granulomas of the breast, besides charcoal granuloma, that show markedly low echogenicity of the lesion and even a cystic mass, and many of them mimic a breast malignancy [28][29][30][31].…”

Section: Discussionmentioning

confidence: 94%

Characteristics of Breast Charcoal Granuloma: A Delayed Complication Following Tattoo Localization

Kim,

Ko,

Han

et al. 2023

Diagnostics

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Rationale and Objective: To evaluate the characteristic clinical and imaging findings of charcoal granuloma and suggest features that may differentiate charcoal granuloma from breast cancer. Materials and Methods: This retrospective study included 18 patients with a histologically confirmed breast charcoal granuloma between 2005 and 2021 at a single institution. All patients had a history of breast surgery after ultrasound (US)-guided charcoal marking. Two radiologists analyzed the radiologic findings of charcoal granulomas, including the presence of a mass or calcification; the shape, margin and density of the masses on mammography; and the location, size, shape, margin, orientation, echogenicity, vascularity, presence of an echogenic halo, and posterior acoustic shadowing on US. In cases with available follow-up images, we also investigated whether the size and shape had changed. Results: The median interval between breast surgery and the diagnosis of charcoal granuloma was 2.3 years (range, 0.7–18.3 years). Thirteen lesions (72.2%) were detected on screening images. In 11 (61.1%) cases, the surgical incision was not made in the tattooed skin area. Mammography showed positive findings in 10/15 patients, and most lesions were isodense masses (70%). There were no cases with calcification. On US, all lesions were masses and showed a taller-than-wide orientation (61.1%), round or oval shape (55.6%), and iso- or hyperechogenicity (83.3%). Echogenic halo (27.8%) and posterior acoustic shadowing (16.7%) were uncommon. On Doppler US, only four cases (22.2%) showed increased vascularity. Most were classified as BI-RADS 3 (38.9%) or 4A (50.0%). After biopsy, 12 patients had follow-up mammography and US. The size of the lesion decreased in nine cases and remained unchanged in three cases. A decrease in the lesion size after biopsy showed a negative correlation with the interval between detection on imaging and biopsy (p = 0.04). Conclusion: Charcoal granuloma is most commonly found 2–3 years after surgery and occurs more frequently when the incision site is different from the tattooed skin area. US findings of tall and round or oval masses with iso- or hyperechogenicity without increased vascularity could help to differentiate them from malignancies.

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Section: Discussionmentioning

confidence: 94%

Characteristics of Breast Charcoal Granuloma: A Delayed Complication Following Tattoo Localization

Kim,

Ko,

Han

et al. 2023

Diagnostics

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“…The inflammatory process with foreign body-type giant cell reaction is known to be associated with increased [ 18 F]FDG uptake on [ 18 F]FDG PET scan (Erdoğan et al 2013 ; Dong et al 2016 ; Miyake et al 2010 ; Rahier and Deprez 2018 ), with reported SUV max ranged at 9.1–28.0 (average: 17.6). In the present case, the markedly intense uptake (SUV max of 68) is rarely observed, likely indicative of rapid tumor response to chemotherapy with extensive tumor necrosis and active inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that macrophages and their fused morphologic variants, the multinucleated giant cells which include the foreign body-type giant cells, are the dominant early responders to biomaterial implantation (Brodbeck and Anderson 2009 ; Sheikh et al 2015 ). Biomaterial and foreign body elicit tissue and cellular responses with associated increased [ 18 F]fluorodeoxyglucose (FDG) uptake have been reported (Erdoğan et al 2013 ; Dong et al 2016 ; Miyake et al 2010 ; Rahier and Deprez 2018 ). Foreign body-type giant cell reaction could also be seen in rapidly dying cells with persistent activation of macrophages, with fusion and the formation of a giant cell, which has not been adequately reported in the literature (Sheikh et al 2015 ; Kahn et al 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Foreign body-type giant cell reaction with extensive granulation tissue and intense inflammation after chemotherapy mimicking residual lymphoma on FDG PET

Kazi

Raptis

Abbaspour

et al. 2022

European J Hybrid Imaging

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Foreign body-type giant cell reaction is typically a biological and immunological reaction to the presence of foreign bodies such as catheters, parasites or biomaterials with a collection of fused macrophages (giant cell). We reported an unusual case of [18F]FDG PET findings in diffuse large B cell lymphoma in the urinary bladder following incomplete resection and chemotherapy. As the restaging [18F]FDG PET showed intense [18F]FDG uptake in the urinary bladder at the resection site concerning for recurrence, the lesion was subsequently resected and histopathology showed extensive granulation tissue with foreign body-type giant cell reaction with no suspected foreign bodies or neoplasia.

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Unusual Delayed FDG-PET/CT Hypermetabolism Due to Charcoal-Induced Granuloma

Cited by 2 publications

References 1 publication

Characteristics of Breast Charcoal Granuloma: A Delayed Complication Following Tattoo Localization

Characteristics of Breast Charcoal Granuloma: A Delayed Complication Following Tattoo Localization

Foreign body-type giant cell reaction with extensive granulation tissue and intense inflammation after chemotherapy mimicking residual lymphoma on FDG PET

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