Tenosynovial giant cell tumors in unusual locations detected by positron emission tomography imaging confused with malignant tumors: report of two cases.

Akihiko Takeuchi,Katsuhiro Hayashi,Kiyokazu Fukui,Hiroyuki Tsuchiya,Taku Oikawa,Shinji Miwa,Masayuki Takahira,Norio Yamamoto

doi:10.1186/s12891-016-1050-7

Akihiko Takeuchi, Katsuhiro Hayashi + Show 6 more

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https://doi.org/10.1186/s12891-016-1050-7

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Abstract

BackgroundA tenosynovial giant cell tumor (T-GCT) is a benign synovial tumor arising from the synovium, bursae, or tendon sheath. It can be intra- or extra-articular and localized or diffuse. Diffuse T-GCT is considered as a locally aggressive. Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose with computed tomography (FDG PET/CT) is widely used to differentiate malignant from benign tumors and to detect distant metastasis. However, FDG PET/CT is limited by false-positive findings. In this study, we present two cases of T-GCT that developed in unusual locations and were confused with malignant tumors. The final diagnoses were histologically confirmed as T-GCTs.Case presentationCase 1. A 45-year-old Japanese female presented with a left choroidal melanoma and an abnormal lesion adjacent to the first cervical (C1) lamina confirmed by a PET scan (maximum standardized uptake value [SUVmax] = 9.9 g/ml). MRI of the neck also detected a soft tissue mass (14.6 × 7.7 × 7 mm) adjacent to the C1 lamina. The choroidal melanoma was treated by heavy carbon ion radiotherapy. Although the size of the C1 soft tissue tumor remained unchanged, a CT-guided biopsy confirmed the diagnosis of the neck mass as a T-GCT.Case 2. A 15-year-old Japanese male with multiple type 1 neurofibromatosis presented with a soft tissue mass (26.1 × 24.7 × 11.5 mm) of the extra-articular hip joint that was coincidentally detected by FDG PET/CT during examination of a mediastinal soft tissue mass. SUVmax of the mediastinal lesion was 2.6 g/ml and of the hip lesion was 12.8 g/ml. Thus, differentiation from a malignant tumor, such as a malignant peripheral nerve sheath tumor, was necessary. An open biopsy was performed, and the frozen section was diagnosed as T-GCT. The tumor was excised, and the final histological diagnosis confirmed T-GCT.ConclusionT-GCT can show high FDG uptake, which might be confused with malignancy. Although MRI findings and location might help in the diagnosis of a T-GCT, careful assessment is mandatory, especially in unusual locations.

Highlights

A tenosynovial giant cell tumor (T-GCT) is a benign synovial tumor arising from the synovium, bursae, or tendon sheath
T-GCT is a benign soft tissue tumor that arises from the synovium, bursae, or tendon sheath that typically contains areas of intermediate and/or low signal intensity on T1- and T2WIs
A T-GCT is usually diagnosed by Magnetic resonance imaging (MRI) [17]

Summary

Introduction

A tenosynovial giant cell tumor (T-GCT) is a benign synovial tumor arising from the synovium, bursae, or tendon sheath. We discuss two cases of T-GCT that developed in unusual locations and were initially thought to be malignant tumors on FDG PET/CT, but were histologically confirmed as T-GCT. FDG PET/CT detected mild FDG uptake in the left choroidal plexus lesion (SUVmax = 3.8 g/ml) and an intensely hypermetabolic extra-articular soft tissue density lesion adjacent to the first cervical (C1) lamina (SUVmax = 9.9 g/ml) (Fig. 2).

Results

Conclusion