Pleomorphic spindle cell sarcoma (PSCS) (formerly known as malignant fibrous histiocytoma, MFH) of the spleen, mimics an atypical haemangioma on^99mTc-RBC, CT and Ultrasound: staging with¹⁸F-FDG PET/CT

Abstract

A 63-year-old male was found to have a 7.5-cm splenic mass that had imaging appearances of an atypical haemangioma on CT, ultrasound and a 99mTc-RBC scan, and he was followed conservatively with serial ultrasounds. Sixteen months later, however, the splenic lesion grew and he developed numerous new liver masses which were biopsy confirmed to be a pleomorphic spindle cell sarcoma (PSCS), formerly known as malignant fibrous histiocytoma (MFH). A staging 18F-FDG PET/CT was performed and showed innumerable, mostly necrotic hepatic and splenic masses. The patient passed away a few days after the PET/CT, before a treatment program could be implemented. The use of 18F-FDG PET/CT in the staging of splenic PSCS has not been previously described. We present the 99mTc-RBC and 18F-FDG PET/CT image characteristics of a patient with splenic PSCS.

Undifferentiated pleomorphic sarcoma of the spleen: a case report and literature review

“…In three cases, the patients presented with splenic rupture associated with haemodynamic compromise [ 28 , 30 , 40 ]. The subject case also presented with a non-specific one-week history of abdominal pain without associated symptomatology or biochemical manifestations [ 7 , 10 , 14 , 17 , 19 , 22 , 25 – 27 , 30 , 33 , 35 , 37 , 38 , 41 , 42 ].…”

Long-term disease-free survival of an undifferentiated pleomorphic sarcoma of the spleen: A case report and literature review

“…Prior literature showed that UPS is FDG avid on FDG-PET/CT, [ 33 – 35 ] which appears to apply to splenic UPS as well. [ 27 ] CT findings as mentioned above may be useful to avoid delaying radical surgery early in the splenic UPS disease course.…”

“…Although a specific antibody for UPS has not been identified, vimentin, CD68, α-SMA and α-antichymotorypsin were often positive in the previous studies (Table 1) . [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Immunohistochemistry may be useful for ruling out specific known lines of differentiation. Splenectomy is the most radical therapy.…”

“…Prior literature showed that UPS is FDG avid on FDG-PET/ CT, [33][34][35] which appears to apply to splenic UPS as well. [27] CT findings as mentioned above may be useful to avoid delaying radical surgery early in the splenic UPS disease course. These days, the diagnostic accuracy and safety of percutaneous image-guided biopsy of the spleen was reported.…”

“…Only 19 total cases have been reported in English literature. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Details of previous studies on splenic UPS, including the present work, are shown (Table 1). Fourteen of the (70.0%) patients were male, and 6 (30.0%) were female.…”