False-Positive Diagnosis of Metastasis on Positron Emission Tomography–Computed Tomography Imaging Due to Hibernoma

Robison, Sean; Rapmund, Andrea; Hemmings, Chris; Fulham, Michael; Barry, Peter

doi:10.1200/jco.2008.19.4977

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…Vassos recently reported that hibernomas show spotty areas of contrast enhancement as well as prominent fibrovascular septa on MRI [ 13 ]. Hibernomas exhibit very high standard uptake values (SUVs) on [18F]fluorodeoxyglucose (FDG)-based positron emission tomography (PET) because they contain abundant mitochondria and are highly metabolically active [ 14 ]. One of our cases of hibernoma showed an SUV >40, suggesting that PET might be useful to distinguish hibernomas from WDL/ALTs (manuscript in preparation).…”

Section: Discussionmentioning

confidence: 99%

Differentiation of lipoma and atypical lipomatous tumor by a scoring system: implication of increased vascularity on pathogenesis of liposarcoma

Nagano

Yokouchi

Setoguchi

et al. 2015

BMC Musculoskelet Disord

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BackgroundWell-differentiated liposarcoma (WDL)/atypical lipomatous tumor (ALT) is considered a low-grade malignancy that rarely metastasizes but should be carefully followed because recurrence or dedifferentiation may occur. It is recognized that WDL and ALT are essentially synonymous, describing lesions that are identical both morphologically and karyotypically, and that site-specific variations in behavior relate only to surgical resectability. Preoperative differential diagnosis between lipoma and ALT has been well studied because their clinical and image characteristics are very similar. We evaluated the factors that may differentiate ALTs from lipomas, and validated a tentative scoring system for the diagnosis of the 2 tumor types.MethodsForty-eight lipomas and 12 ALTs were included. The mean age, location and depth of the tumor as well as the compartment were not significantly different between the 2 groups. To evaluate the vascularity of the tumors, the average number of intratumoral vessels on pathological sections was calculated and compared between cases of lipoma and ALT.ResultsThe tumor size was significantly larger in ALT cases than in lipoma cases (P < 0.001). Magnetic resonance imaging (MRI) revealed septal structures in 91.6% of ALTs, whereas 20.8% of lipomas showed septa. Contrast enhancement in MRI was found significantly more often in ALTs (81.2%) than in lipomas (18.8%) (P < 0.001). We created a “ALT score” to discriminate between lipoma and ALT (0–6 points). ALT cases gave significantly higher point values (average 5.1 points) than lipoma cases (average 1.7 points) (P < 0.001). We found a significantly increased number of vessels in cases of ALT than in cases of lipoma (P = 0.001).ConclusionsOur ALT score may help surgeons to differentiate a suspected ALT from a lipoma and could recommend a marginal resection in cases of suspected ALT. Increased intratumoral vascularity in ALT is reflected in the MRI findings and may play a key role in the acquisition of a malignant phenotype in adipocytic tumors.

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Section: Discussionmentioning

confidence: 99%

Differentiation of lipoma and atypical lipomatous tumor by a scoring system: implication of increased vascularity on pathogenesis of liposarcoma

Nagano

Yokouchi

Setoguchi

et al. 2015

BMC Musculoskelet Disord

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“…Since hibernomas derive from brown fat, which promotes non-shivering thermogenesis in newborns and hibernating animals, it may show a high glucose metabolism. Not surprisingly this diagnostic problem did not surface until FDG PET found widespread use in clinical oncology [3]. In the setting of patients with a high pretest probability of metastases, as in the case we presented above, chances are high of misinterpreting the high FDG uptake as evidence for metastasis and unnecessarily administer cancer therapy.…”

Section: Discussionmentioning

confidence: 95%

“…Brown adipocytes contain a very large number of mitochondria and may exhibit an extraordinary metabolic activity [2] leading to a high FDG uptake in PET mimicking malignancy. Until recently [3] it has been postulated that hibernomas are rarely associated with another malignant tumor, but recent personal experience has led us to reconsider this topic.…”

Section: Introductionmentioning

confidence: 99%

The Importance of Recognizing Hibernomas as Possibly Not So Rare Pitfalls in FDG PET—A Histologically Verified Case and Literature Review

Leitha¹,

Reiner-Concin²,

Hurtl³

2013

AMI

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We present a glucose avid hibernoma hampering the re-staging of advanced breast cancer with FDG PET and summarize the results of the available literature. FDG PET, CT, MRI, ultrasound and histology were performed according to standardized protocols in our case. The literature search was performed on PubMed.gov. The literature search revealed 29 relevant publications starting with 2002. The high metabolic activity of hibernomas is a precarious pitfall in the staging of patients with a high pretest probability of malignancy and an increasing number of published cases indicate a possibly underestimated problem necessitating histological work-up in most cases. In our experience and in accordance with the literature unusually high uptake of a lesion and fat equivalent density in the CT should raise the suspicion for a hibernoma. The differential diagnosis between hibernomas and liposarcoma is often impossible without biopsy and histological work-up to prevent unnecessary treatment.

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Breast Chapter

Henderson¹,

Diller²

2015

Pediatric Oncology

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False-Positive Diagnosis of Metastasis on Positron Emission Tomography–Computed Tomography Imaging Due to Hibernoma

Cited by 5 publications

References 7 publications

Differentiation of lipoma and atypical lipomatous tumor by a scoring system: implication of increased vascularity on pathogenesis of liposarcoma

Differentiation of lipoma and atypical lipomatous tumor by a scoring system: implication of increased vascularity on pathogenesis of liposarcoma

The Importance of Recognizing Hibernomas as Possibly Not So Rare Pitfalls in FDG PET—A Histologically Verified Case and Literature Review

Breast Chapter

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