Hibernoma: Intense Uptake on F18-FDG PET/CT
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CASE REPORT
Hibernoma: Intense Uptake on F18-FDG PET/CT Jong Deok Kim & Hang Woo Lee
Received: 10 April 2012 / Revised: 13 May 2012 / Accepted: 1 June 2012 / Published online: 27 June 2012 # Korean Society of Nuclear Medicine 2012
Abstract Hibernoma is a rare benign but metabolically active tumor of brown fat origin, that can have cross-sectional imaging characteristics similar to those of other fat-containing tumors, such as lipomas and liposarcomas, and its presence can lead to false-positive interpretation by exhibiting increased F18-fluorodeoxyglucose (F18-FDG) activity. A 46-year-old woman was diagnosed with dermatofibrosarcoma protuberans underwent F18-FDG positron emission tomography/computed tomography (PET/CT) for detecting recurrence after excision. F18-FDG PET/CT showed incidental intense uptake in the back in addition to increased F18-FDG uptake at the previous lesion site. To our knowledge, this is the first case report of intense F18-FDG uptake in hibernoma in Korea. Keywords Hibernoma . Dermatofibrosarcoma protuberance . PET/CT
Introduction Hibernomas are rare benign tumors of brown fat which can be distinguished histologically from other fatty tumors such as lipomas and liposarcomas. Hibernomas usually present as a heterogenous low-attenuation mass on computed tomography (CT), and as a T1 and T2 heterogenous mass on magnetic J. D. Kim (*) Department of Diagnostic Radiology & Nuclear Medicine, Busan St. Mary’s Medical Center, 538-41, Yongho-Dong, Nam-Gu, Busan 608-838, Republic of Korea e-mail: [email protected] H. W. Lee Department of Neurosurgery, Busan St. Mary’s Medical Center, 538-41, Yongho-Dong, Nam-Gu, Busan 608-838, Republic of Korea
resonance imaging (MRI). Most hibernomas present as a painless mass and an incidental finding on physical examination or imaging. After resection, the tumors generally do not recur and not known to metastasize [1]. We present the case of a hibernoma that was incidentally detected by F18-fluorodeoxyglucose (F18-FDG) positron emission tomography (PET)/CT.
Case Report A 46-year-old woman, who had undergone surgical removal of a dermatofibrosarcoma protuberans in the left retromastoid area in March 2011 presented for an evaluation of a recurrent palpable mass and two other back masses that she had noted several months earlier. In October 2011, F18-FDG PET/CT was performed. This revealed relatively mild F18-FDG uptake at the previous lesion site with a maximum standardized uptake value (SUVmax) of 2.75 (Fig. 1a, b). A 2×4×4.5-cm sized, hypermetabolic mass in the subcutaneous layer of the left back at the level of the 9th to 10th thoracic vertebra with SUVmax of 12.83 in a 1-h image (Fig. 2a–f) and 20.83 in a 2-h image (not shown), respectively. A subsequent contrastenhanced MRI confirmed the location of the left back mass with heterogenous T1 and T2 hyperintensity (hypointense to adjacent subcutaneous fat) (Fig. 3a, b) and intense enhancement after contrast injection with a linear hyperintensity entering the mass (Fig. 3c, d). The mass was not suppressed on f
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