Case Report: Pleuropulmonary Blastoma in a 2.5-Year-Old Boy: 18F-FDG PET/CT Findings

Dan Ruan,Long Sun

doi:10.3389/fnume.2021.780485

Abstract

Pleuropulmonary blastoma (PPB) is a rare invasive primary malignancy in the thoracic cavity that occurs mainly in infants and children. It is often misdiagnosed and not treated correctly and promptly due to the lack of specificity of clinical symptoms and conventional imaging presentations. We report a 2.5-year-old boy who underwent X-ray chest radiography, chest CT, and 18F-FDG PET/CT. PET/CT images demonstrated a sizeable cystic-solid mass with heterogeneous increased glucose metabolism in the left thoracic cavity. The diagnosis of PPB (type II) was finally confirmed by a CT-guided puncture biopsy of the active tumor tissue. This case highlights the critical role of 18F-FDG PET/CT in the diagnosis of PPB in children.

Highlights

Pleuropulmonary blastoma (PPB) is a rare malignant tumor of pleura or lung origin, often located in the lung periphery and invading the chest wall, mediastinum, thoracic vessels, lymph nodes, and diaphragm [1]
The application of 18F-FDG PET/CT in PPB has rarely been reported. We present this case report mainly to demonstrate the diagnostic value of 18F-FDG PET/CT in pediatric PPB patients
Type II and III PPB are usually large and prone to distant metastases, commonly occurring in the brain, spinal cord, and bone [12, 13]. 18F-FDG PET/CT can clearly show the adjacent tissue invasion and distant organ metastases. Another important aspect is the ability of 18F-FDG PET/CT to detect active tumor cell enrichment sites and accurately guide targeted biopsies, which was well-demonstrated in our case

Summary

INTRODUCTION

Pleuropulmonary blastoma (PPB) is a rare malignant tumor of pleura or lung origin, often located in the lung periphery and invading the chest wall, mediastinum, thoracic vessels, lymph nodes, and diaphragm [1]. When children present with this lung inflammation-like condition, the routine imaging examination on admission is a chest radiograph. The maximum intensity projection (MIP) image (Figure 3A) showed a mass with heterogeneous 18F-FDG uptake occupying almost the entire left thoracic cavity. The fever had persisted for 3 days, during which he had an occasional cough with sputum His emergency blood tests showed a higher than normal white blood cell count (13.4 × 109/L) and C-reactive protein (51 mg/L) but a normal neutrophil ratio (60.2%). The lung window CT image (Figure 2A) showed complete solidity of the left thoracic cavity and a mild shift of the mediastinum to the right. The mediastinal window CT image (Figure 2B) revealed a large, heterogeneous density lesion in the left thoracic cavity, which consisted of multiple slightly hypodense solid

DISCUSSION

CONCLUSION

Findings

DATA AVAILABILITY STATEMENT