Abstract
We present a glucose avid hibernoma hampering the re-staging of advanced breast cancer with FDG PET and summarize the results of the available literature. FDG PET, CT, MRI, ultrasound and histology were performed according to standardized protocols in our case. The literature search was performed on PubMed.gov. The literature search revealed 29 relevant publications starting with 2002. The high metabolic activity of hibernomas is a precarious pitfall in the staging of patients with a high pretest probability of malignancy and an increasing number of published cases indicate a possibly underestimated problem necessitating histological work-up in most cases. In our experience and in accordance with the literature unusually high uptake of a lesion and fat equivalent density in the CT should raise the suspicion for a hibernoma. The differential diagnosis between hibernomas and liposarcoma is often impossible without biopsy and histological work-up to prevent unnecessary treatment.
Highlights
Hibernomas are rare benign tumors composed at least in part of brown fat cells, admixed in variable proportion with white adipose tissue
We present a glucose avid hibernoma hampering the re-staging of advanced breast cancer with FDG PET and summarize the results of the available literature
Since hibernomas derive from brown fat, which promotes non-shivering thermogenesis in newborns and hibernating animals, it may show a high glucose metabolism
Summary
Hibernomas are rare benign tumors composed at least in part of brown fat cells, admixed in variable proportion with white adipose tissue. They arise from remnants of fetal brown fat, which is gradually replaced by white fat after the first postnatal weeks. Hibernomas most commonly occur where residual brown fat is found, but a wide range of anatomic locations have been described in the literature. Brown adipocytes contain a very large number of mitochondria and may exhibit an extraordinary metabolic activity [2] leading to a high FDG uptake in PET mimicking malignancy. Until recently [3] it has been postulated that hibernomas are rarely associated with another malignant tumor, but recent personal experience has led us to reconsider this topic
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