Download PDF
CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(01): 66-68
DOI: 10.4103/wjnm.WJNM_11_18
Case Report

Can we differentiate malignant peripheral nerve sheath tumor from benign neurofibroma without invasive sampling

Fikri Selcuk Simsek
Department of Nuclear Medicine, Firat University Medical Faculty, Elazığ, Turkey
,
Saadet Akarsu
1   Department of Paediatric Oncology, Firat University Medical Faculty, Elazığ, Turkey
,
Yavuz Narin
2   Department of Nuclear Medicine, Elazig Medical Park Hospital, Elazığ, Turkey
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Abstract

One of the most important benign tumors in neurofibromatosis type 1 (NF1) is plexiform neurofibroma, and there is a risk of developing malignant peripheral nerve sheath tumor (MPNST) throughout life approximately 10%. However lesion characterization by anatomical imaging methods are not possible. Because of that most of cases goes to biopsy. Using of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) for lesion characterization can be helpful in NF1 patients. We aimed to present an example of the efficacy of FDG-PET/CT in distinguishing benign neurofibroma from MPNST. A 6-year-old male patient who had NF1 admitted to emergency service due to high fever. Acute upper respiratory tract infection was diagnosed; antipyretic and abundant fluid intake was suggested. When high fever continued, the patient referred to our hospital on detection of axillary lymphadenopathy. Leukocytosis was detected in patient's blood count. Sedimentation was 54 mm/h, C-reactive protein 166 g/L, and lactate dehydrogenase 276U/L. Blood and throat cultures did not show pathogenic bacteria. In serological tests, VZV-IgG, EBV-VCA-IgG, and CMV-IgG were avidite positive; Hepatitis B Ag, Anti-HIV, Anti-HAV IgG and IgM, Anti-HCV, EBV-VCA IgM, and VZV-IgM were negative. Based on these results, cervical and thoracic contrast-enhanced computed tomography was performed on preliminary diagnosis of MPNST. Solid lesions with rounded margins, large one being 49 mm in size, that extend from superior mediastinum to posterior mediastinum, left axillary region, and left part of neck were detected, and they were surrounding the vascular structures. Since neurofibroma, MPNST, and lymphoma could not be distinguished, patient referred to FDG-PET/CT scanning. In FDG-PET/CT, highest lesion maximum standardized uptake value (SUVmax) was 1.5; SUVmaxlesion/SUVmaxliver 1.0, and SUVmax/ SUV mean liver 1.5. Biopsy from mediastinal and axillary region did not have LN structure and was positive for S-100 immunostaining, and patient was diagnosed as benign neurofibroma. We believe that there is no need for biopsy in lesions considered benign based on FDG-PET/CT parameters.

Keywords

Malignant peripheral nerve sheath tumor - neurofibromatosis - positron-emission tomography/computed tomography

Financial support and sponsorship

Nil.




Publication History

Received: 00 00 2019

Accepted: 00 00 2019

Article published online:
22 April 2022

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Hersh JH, American Academy of Pediatrics Committee on Genetics. Health supervision for children with neurofibromatosis. Pediatrics 2008;121:633-42.
  • 2 Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: Distribution of diagnoses by age, sex, and location. AJR Am J Roentgenol 1995;164:129-34.
  • 3 Walker L, Thompson D, Easton D, Ponder B, Ponder M, Frayling I, et al. Aprospective study of neurofibromatosis type 1 cancer incidence in the UK. Br J Cancer 2006;95:233-8
  • 4 Tovmassian D, Abdul Razak M, London K. The role of [18F] FDG-PET/CT in predicting malignant transformation of plexiform neurofibromas in neurofibromatosis-1hindawi publishing corporation. Int J Surg Oncol 2016;2016:7.
  • 5 Warbey VS, Ferner RE, Dunn JT, Calonje E, O'Doherty MJ. [18F] FDG PET/CT in the diagnosis of malignant peripheral nerve sheath tumours in neurofibromatosis type-1. Eur J Nucl Med Mol Imaging 2009;36:751-7.
  • 6 Ferner RE, Golding JF, Smith M, Calonje E, Jan W, Sanjayanathan V, et al. [18F] 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a diagnostic tool for neurofibromatosis 1 (NF1) associated malignant peripheral nerve sheath tumours (MPNSTs): A long-term clinical study. Ann Oncol 2008;19:390-4.
  • 7 Combemale P, Valeyrie-Allanore L, Giammarile F, Pinson S, Guillot B, Goulart DM, et al. Utility of 18F-FDG PET with a semi-quantitative index in the detection of sarcomatous transformation in patients with neurofibromatosis type 1. PLoS One 2014;9:e85954.
  • 8 Matsumine A, Kusuzaki K, Nakamura T, Nakazora S, Niimi R, Matsubara T, et al. Differentiation between neurofibromas and malignant peripheral nerve sheath tumors in neurofibromatosis 1 evaluated by MRI. J Cancer Res Clin Oncol 2009;135:891-900.
  • 9 Demehri S, Belzberg A, Blakeley J, Fayad LM. Conventional and functional MR imaging of peripheral nerve sheath tumors: Initial experience. AJNR Am J Neuroradiol 2014;35:1615-20.
  • 10 Salamon J, Papp L, Tóth Z, Laqmani A, Apostolova I, Adam G, et al. Nerve sheath tumors in neurofibromatosis type 1: Assessment of whole-body metabolic tumor burden using F-18-FDG PET/CT. PLoS One 2015;10:e0143305.