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      A case of plastron appendicitis mimicking malignant cecal tumor in flourodeoxyglucose-positron emission tomography/computed tomography study

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          Abstract

          In recent years, flourodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) has been used intensively in the field of oncology. However, an increase in FDG uptake has been observed both in malignant tissues, and inflammatory processes. Therefore false-positive results have appeared. We present a 70-year-old male patient who presented to the hospital with right lower quadrant pain. A right lower quadrant mass was observed with conventional methods, and PET/CT was performed which revealed a hypermetabolic mass in the right lower quadrant. The patient was referred to the surgery with a suspect malignant mass whose histopathological report indicated plastron appendicitis. Although FDG PET/CT is a reliable method in the evaluation of oncological cases, false-positivities should be taken into consideration in inflammatory processes.

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          71,000 HUMAN APPENDIX SPECIMENS. A FINAL REPORT, SUMMARIZING FORTY YEARS' STUDY.

          Louis Collins (1963)
          Article 0 comments Cited 47 times – based on 0 reviews     Review now
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            Selectivity of 18F-FLT and 18F-FDG for differentiating tumor from inflammation in a rodent model.

            Aren van Waarde, Bram Maas, Philip H. Elsinga … (2004)
            Increased glucose metabolism of inflammatory tissues is the main source of false-positive (18)F-FDG PET findings in oncology. It has been suggested that radiolabeled nucleosides might be more tumor specific. To test this hypothesis, we compared the biodistribution of 3'-deoxy-3'-(18)F-fluorothymidine (FLT) and (18)F-FDG in Wistar rats that bore tumors (C6 rat glioma in the right shoulder) and also had sterile inflammation in the left calf muscle (induced by injection of 0.1 mL of turpentine). Twenty-four hours after turpentine injection, the rats received an intravenous bolus (30 MBq) of either (18)F-FLT (n = 5) or (18)F-FDG (n = 5). Pretreatment of the animals with thymidine phosphorylase (>1,000 U/kg, intravenously) before injection of (18)F-FLT proved to be necessary to reduce the serum levels of endogenous thymidine and achieve satisfactory tumor uptake of radioactivity. Tumor-to-muscle ratios of (18)F-FDG at 2 h after injection (13.2 +/- 3.0) were higher than those of (18)F-FLT (3.8 +/- 1.3). (18)F-FDG showed high physiologic uptake in brain and heart, whereas (18)F-FLT was avidly taken up by bone marrow. (18)F-FDG accumulated in the inflamed muscle, with 4.8 +/- 1.2 times higher uptake in the affected thigh than in the contralateral healthy thigh, in contrast to (18)F-FLT, for which this ratio was not significantly different from unity (1.3 +/- 0.4). In (18)F-FDG PET images, both tumor and inflammation were visible, but (18)F-FLT PET showed only the tumor. Thus, the hypothesis that (18)F-FLT has a higher tumor specificity was confirmed in our animal model.
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              Functional imaging of inflammatory diseases using nuclear medicine techniques.

              Drew A Torigian, Wengen Chen, Hongming Zhuang … (2009)
              Molecular imaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) is increasingly used to diagnose, characterize, and monitor disease activity in the setting of inflammatory disorders of known and unknown etiology. These disorders include sarcoidosis, atherosclerosis, vasculitis, inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and degenerative joint disease. Gallium-67 ((67)Ga) citrate, labeled leukocytes with technetium-99m ((99m)Tc) or indium-111 ((111)In), and (18)F-fluorodeoxyglucose (FDG) represent the most widely used radiopharmaceutical agents. However, other preparations, such as labeled murine monoclonal antigranulocyte antibodies and labeled human polyclonal nonspecific immunoglobulin G, chemotactic peptides, interleukins, chemokines, and liposomes, have been used to image inflammation. Also, (99m)Tc nanocolloid scintigraphy has been found to be suitable for bone and joint diseases, especially RA. Among the single photon emitting imaging agents, the recommended radiotracer for abdominal inflammation has been (99m)Tc-hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes. During the last several years, FDG-PET imaging has been shown to have great value for the detection of inflammation and has become the centerpiece of such initiatives. This very powerful technique will play an increasingly important role in the management of patients with inflammatory conditions. FDG-PET can provide valuable information in patients with pulmonary and extrapulmonary sarcoidosis, and is a useful tool for testing the efficacy of various treatments. FDG-PET combined with computed tomography holds great promise for assessing atherosclerosis of the large arteries. This modality is very sensitive in detecting large-vessel vasculitis and can be used to monitor the disease course. FDG-PET is also being used to study the inflamed synovial joints both in the experimental and clinical settings, especially for the investigation and management of RA and degenerative joint disease. This technique also has the potential to become the imaging modality of choice in assessing IBD, replacing radiolabeled autologous leukocyte imaging in this setting. Detection of inflammation in the lungs and airways may improve our knowledge about a multitude of disorders that affect these structures. Therefore, functional imaging, led by FDG-PET imaging, is likely to play an increasingly critical role in assessing inflammatory disorders of known and unknown etiologies, and will improve their management immensely in the future.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Nucl Med
                Journal ID (iso-abbrev): Indian J Nucl Med
                Journal ID (publisher-id): IJNM
                Title: Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0972-3919
                ISSN (Electronic): 0974-0244
                Publication date (Print): Jul-Sep 2015
                Volume: 30
                Issue: 3
                Pages: 256-258
                Affiliations
                [1]Department of Nuclear Medicine, Afyon Kocatepe University, School of Medicine, Afyon, Turkey
                [1 ]Department of Nuclear Medicine, Akdeniz University, School of Medicine, Antalya, Turkey
                [2 ]Department of Radiology, Akdeniz University, School of Medicine, Antalya, Turkey
                Author notes
                Address for correspondence: Dr. Adil Boz, Department of Nuclear Medicine, Akdeniz University, School of Medicine, Antalya 07070, Turkey. E-mail: boz@ 123456akdeniz.edu.tr
                Article
                Publisher ID: IJNM-30-256
                DOI: 10.4103/0972-3919.151653
                PMC ID: 4479917
                SO-VID: 478bc0a0-b56e-4e99-b160-87971e8fcc7f
                Copyright © Copyright: © Indian Journal of Nuclear Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: flourodeoxyglucose-positron emission tomography/computed tomography,malignant cecal tumor,mimic,plastron appendicitis
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: flourodeoxyglucose-positron emission tomography/computed tomography, malignant cecal tumor, mimic, plastron appendicitis

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