Xanthogranulomatous gastritis mimicking malignant GIST on F-18 FDG PET
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CASE REPORT
Xanthogranulomatous gastritis mimicking malignant GIST on F-18 FDG PET Tomoya Tsukada • Tatsuo Nakano • Takashi Miyata • Shozo Sasaki • Kotaro Higashi
Received: 4 April 2012 / Accepted: 10 June 2012 / Published online: 29 June 2012 Ó The Japanese Society of Nuclear Medicine 2012
Abstract Xanthogranulomatous gastritis (XGG) is a rare inflammatory lesion of the stomach, with only 11 reported cases worldwide. Furthermore, reports on the use of detailed diagnostic imaging in XGG are not available. Herein, we describe a case of XGG with detailed diagnostic imaging mimicking malignant gastrointestinal stromal tumor (GIST) in light of the current literature. A 79-yearold woman who presented with epigastric pain was referred to our hospital. Upper gastrointestinal endoscopy revealed an elevated lesion similar to a submucosal tumor (SMT). F-18 fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) showed intense FDG uptake in the mass. Additional imaging studies revealed a malignant GIST, which was suspected of having infiltrated the left lobe of the liver. Open surgery was carried out, but tumorous lesions were not found. For exact histopathological diagnosis, partial resection of the thickening gastric wall was performed, and XGG was diagnosed. We conclude that benign conditions, including XGG, should be considered when intense FDG uptake in SMT is found.
T. Tsukada (&) T. Miyata Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan e-mail: [email protected]
Keywords
Xanthogranuloma Stomach FDG PET
Introduction Xanthogranulomatous inflammation is a rare inflammatory lesion characterized by marked proliferative fibrosis with infiltration of foamy histiocytes and other inflammatory cells. Xanthogranulomatous inflammation is common in the gall bladder, where it is referred to as xanthogranulomatous cholecystitis [1, 2], and the kidneys [3]. Xanthogranulomatous inflammation also occurs in various organs such as the pancreas [4], colon [5], female genital organs [6], and stomach [7]. Xanthogranulomatous gastritis (XGG) is an extremely rare disease, and only 11 cases have been reported [7–17]. In all cases, XGG was preoperatively misdiagnosed as submucosal tumor (SMT) or advanced gastric cancer. Recently, F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been used to successfully distinguish benign lesions from malignant disease in the gall bladder [18, 19]. However, it is difficult to differentiate between xanthogranulomatous inflammation and malignancy using this method as FDG is not specific for malignant lesions and can accumulate in inflammatory lesions with increased glucose metabolism [2]. Furthermore, detailed diagnostic imaging in XGG has not been reported thus far. Here, we describe a case of XGG with detailed diagnostic imaging and review the case in light of the current literature.
T. Tsukada T.
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