F-18 FDG accumulation in mucinous cystic neoplasm of pancreas
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Published on: January 22, 2018
Motohiro Sato1, Takashi Hiyama, Keiko Kato
1Departments of Radiology, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan. mo-sato@chubyoin.pref.ibaraki.jp
Abstract:
We report a case of mucinous cystic neoplasm which showed FDG accumulation in its cyst wall. MRI revealed that this tumor had repeated intracystic hemorrhage. Inhomogeneous FDG accumulation was found in the cyst wall. The epithelium was focally denuded and ovarian-like stroma with macrophage migration, which phagocytosed red blood cells, and fibrosis were recognized on histopathological examination. These histopathological findings suggested that FDG accumulates not in the monolayer epithelium but in ovarian-like stroma with macrophage migration and fibrosis. Macrophage migration and fibrosis were considered to have contributed to FDG accumulation in this mucinous cystic neoplasm.
Insights
This study explains how mucinous cystic neoplasms accumulate FDG, highlighting the role of ovarian-like stroma, macrophage migration, and fibrosis in the cyst wall. These factors, not the epithelium, drive the observed FDG uptake.
Area of Science:
- Oncology
- Medical Imaging
- Pathology
Background:
- Mucinous cystic neoplasms (MCNs) are ovarian tumors with varying malignant potential.
- Understanding the mechanisms of fluorodeoxyglucose (FDG) uptake in MCNs is crucial for accurate diagnosis and staging.
- Positron emission tomography (PET) with FDG is a common imaging modality for oncological assessment.
Observation:
- A case of MCN presented with heterogeneous FDG accumulation in the cyst wall on PET-CT scans.
- Magnetic resonance imaging (MRI) indicated recurrent intracystic hemorrhage within the tumor.
- Histopathological examination revealed focal epithelial denudation, ovarian-like stroma, macrophage infiltration with phagocytosed red blood cells, and fibrosis.
Findings:
- FDG accumulation was primarily localized to the ovarian-like stroma, not the neoplastic epithelium.
- Macrophage migration and phagocytosis of red blood cells within the stroma were prominent features.
- Fibrosis in the ovarian-like stroma also contributed to the observed FDG uptake.
Implications:
- The findings suggest that FDG uptake in this MCN case is driven by stromal inflammatory and reparative processes, including macrophage activity and fibrosis, rather than solely by epithelial proliferation.
- This understanding may refine the interpretation of FDG-PET/CT scans for MCNs, potentially improving diagnostic accuracy.
- Further research is warranted to explore the specific cellular and molecular mechanisms underlying FDG accumulation in the stromal component of MCNs.