Epithelioid Hemangioma of Vertebra Mimicking Metastasis on FDG PET/CT in a Patient With Renal Cell Cancer

Abstract

Vertebral epithelioid hemangioma is a rare vascular tumor composed of the many vessels lined by distinct epithelioid endothelial cells. We present the case of a patient with renal cell cancer (RCC) and suspicious vertebral metastasis presenting with back pain, who was later found to have epithelioid hemangioma. FDG PET/CT demonstrated uptake of FDG not only in RCC, but also in the sixth thoracic vertebral body. The SUVmax of the vertebra was more than twice as high as RCC. This report indicates importance of quantitative assessment of FDG uptake, as well as combined use of MRI.

Solitary Lymph Node Metastasis From a Malignant Peripheral Nerve Sheath Tumor of the Thoracic Vertebra Revealed on FDG PET/CT

“…Our case reported a rare phenomenon manifesting as solitary axillary lymph node metastasis for primary bone MPNST. Similar imaging findings in the vertebral column on PET/CT should consider the possibility of lymphoma, 6,7 chordoma, 8 metastasis, 9 epithelioid hemangioma, 10 tenosynovial giant cell tumor, 11 myeloma, 12 and Rosai-Dorfman disease 13 . This case highlights that solitary lytic thoracic vertebral lesion with intense FDG uptake should regard MPNST as a differential diagnosis and that FDG PET/CT has an important role in the initial staging of MPNST 14–16 …”

Dual-Time-Point 18F-FDG PET/CT for Differentiating a Chest Wall Hemangioma From a Malignant Metastasis

“…2,3 Hemangiomas normally show no or mild FDG uptake, although atypical presentation with high metabolism has been reported. 4 Dual-time-point FDG PET/CT scans can provide additional information from differences in FDG uptake at a later time point 5 despite similar initial accumulation of FDG by either malignant cells or inflammatory cells. This imaging technique has been used for malignancies of the lung, breast, head and neck, pancreas, bowel, and musculoskeletal system, [6][7][8][9][10] and has improved accuracy in the detection of malignancies 11 and prediction of prognoses.…”

“…18 F-FDG PET/CT can differentiate malignant tumors from benign vascular tumors 2,3. Hemangiomas normally show no or mild FDG uptake, although atypical presentation with high metabolism has been reported 4. Dual-time-point FDG PET/CT scans can provide additional information from differences in FDG uptake at a later time point5 despite similar initial accumulation of FDG by either malignant cells or inflammatory cells.…”