Lhermitte-Duclos disease: 11C-methionine positron emission tomography data in 4 patients

Calenbergh, Frank Van; Vantomme, Nikolaas; Flamen, Patrick; Demaerel, Philippe; Sciot, Raf; Legius, Eric; Mortelmans, Luc; Plets, Chris

doi:10.1016/j.surneu.2005.06.031

Cited by 17 publications

(11 citation statements)

References 12 publications

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“…corresponding to the pathologic finding of thickened cerebellar folia. 11C-methionine-PET also shows a high uptake area associated with the lesion (Van Calenbergh et al 2006). MR may also be useful in determining the presence of residual tumor (Marano et al 1988;Reeder et al 1988;Smith et al 1989;Ashley et al 1990;Faillot et al 1990).…”

Section: Treatment and Clinical Outcomementioning

confidence: 99%

Uncommon glial tumors

Chen¹,

Elder²,

González-Gómez³

et al. 2012

Brain Tumors

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Section: Treatment and Clinical Outcomementioning

confidence: 99%

Uncommon glial tumors

Chen¹,

Elder²,

González-Gómez³

et al. 2012

Brain Tumors

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“…Magnetic resonance imaging (MRI) is considered to be the best modality imaging option for characterization of LDD by some authors [ 1 , 3 , 5 ] but the impact of functional imaging provided by nuclear medicine is recommended in other studies [ 2 , 5 , 6 ]. Various authors have described the potential role of molecular imaging provided by positron emission tomography (PET) and single-photon emission computed tomography in the metabolic evaluation of LDD, by using radiotracers such as fluorine-18-fluorodeoxyglucose (F18-FDG) [ 2 , 5 , 6 ], thallium-201 [ 5 ] and C11-methionine [ 7 ]. The potential added value of metabolic imaging lies in the possibility to calculate metabolic activity of a lesion by the measurement of the maximum standardized uptake value (SUV max ), the ratio between the average radioactivity registered in a lesion and the administered amount of the same tracer [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Lhermitte-Duclos disease presenting with positron emission tomography-magnetic resonance fusion imaging: a case report

et al. 2012

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IntroductionLhermitte-Duclos disease or dysplastic gangliocytoma of the cerebellum is an extremely rare tumor. It is a slowly enlarging mass within the cerebellar cortex. The majority of cases are diagnosed in the third or fourth decade of life.Case presentationWe report the case of a 37-year-old Caucasian woman who underwent positron emission tomography-computed tomography with fluorine-18-fluorodeoxyglucose for evaluation of a solitary lung node. No pathological uptake was detected in the solitary lung node but the positron emission tomography-computed tomography of her brain showed intense tracer uptake, suggestive of a malignant neoplasm, in a mass in her left cerebellar lobe. Our patient had experienced two years of occipital headache and movement disorder. Subsequently, magnetic resonance imaging was performed with contrast agent administration, showing a large subtentorial mass in her left cerebellar hemisphere, with compression and dislocation of the fourth ventricle. Metabolic data provided by positron emission tomography and morphological magnetic resonance imaging views were fused in post-processing, allowing a diagnosis of dysplastic gangliocytoma with increased glucose metabolism. Total resection of the tumor was performed and histological examination confirmed the diagnosis of Lhermitte-Duclos disease.ConclusionsOur case indicates that increased uptake of fluorine-18-fluorodeoxyglucose may be misinterpreted as a neoplastic process in the evaluation of patients with Lhermitte-Duclos disease, but supports the usefulness of integrated positron emission tomography-magnetic resonance imaging in the exact pathophysiologic explanation of this disease and in making the correct diagnosis. However, an accurate physical examination and exact knowledge of clinical data is of the utmost importance.

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“…In our case it may have reflected focally increased neuronal cell density and/or a different glucose metabolism for these dysplastic cells. On FDG-and methionine PET scans, the lesion in LhermitteDuclos disease, a distinct entity of dysplastic gangliocytoma of the cerebellum, is also reportedly visualized as a high-uptake area reflecting increased neuronal cell density and a dysregulated glucose-and amino acid metabolism not related with cell proliferation [4,5]. In our patient, the increased tracer uptake could be attributable to microvessels with luminal enlargement and branching as shown by CD31 immunohistochemistry.…”

Section: To the Editormentioning

confidence: 59%

Gangliocytoma of the medulla oblongata demonstrating high tracer uptake on positron emission tomography

et al. 2011

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Gangliocytomas are rare central nervous tumors mainly involving supratentorial region and occuring primarily in children and young adults. We present a rare case of gangliocytoma of medulla oblongata in a 48-year-old man demonstrating higher tracer uptake on positron emission tomography (PET) scans.A 48-year-old apparently healthy man was found to have an isodense suboccipital mass lesion with calcifications on CT brain check-up. T2-weighted MRI showed a mixed-intensity tumor with a small cyst in the right cerebellomedullary cistern (Fig. 1a). It was slightly enhanced on T1-weighted gadolinium-enhanced MRI scans. The tumor appeared to have arisen in the lateral part of the medulla oblongata with no clear demarcation from the brainstem. FDG- (Fig. 1b) and methionine PET ( Fig. 1c) studies were performed and measurement of the equilibrated radioactivity 5 min after the i.v. injection of FDG (211 MBq) and MET (200 MBq), respectively, clearly showed increased tracer uptake. On approaching the tumor via suboccipital craniotomy, a soft grayish mass in the cerebellomedullary cistern was seen involving the lower cranial nerves, which made us limit the intervention to biopsy (Fig. 1d). His postoperative course was uneventful.MRI studies performed 16 months later yielded no evidence of tumor growth. Hematoxylin and eosin staining showed scattered large to medium-sized atypical ganglion cells with ample cytoplasm containing Nissl bodies in a normocellular and non-neoplastic glial background (Fig. 1e). Immunohistochemically, the tumor cells were strongly positive for synaptophysin and neurofilament. The glial background was faintly positive for GFAP (photo not shown). The MIB-1 labeling index was \1%. CD31 immunohistochemistry revealed a moderately dense scattering of microvessels which were well branched and often enlarged (Fig. 1f).Gangliocytomas are composed of mature atypical neuronal cells that constitute the sole neoplastic components. The most common site of gangliocytoma is the cerebral hemisphere, the preferred site being the temporal lobe. In our patient the tumor arose in the lateral part of the medulla oblongata. It was primarily composed of multipolar cells with ample eosinophilic cytoplasm that included Nissl bodies distributed perisomatically. The cells were positive for synaptophysin and neurofilament. A few astrocytes without neoplastic features were also seen. To the best of our knowledge, ours is the 3rd documented case of gangliocytoma arising in the brainstem. The two patients reported earlier were a 12 year-old boy [1] and an infant with prolonged expiratory apnea with progressively increasing severity [2].Our PET studies showed interesting findings. Although the lesion was a benign tumor with low cellularity, it manifested increased uptake of tracers on FDG-and methionine PET scans. The mechanism of high FDG uptake in malignant tumors is attributable to several factors including an increased overall cell metabolism, the upregulation of enzymatic activity of Glut-1 or hexokinase, and increased cell dens...

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Lhermitte-Duclos disease: 11C-methionine positron emission tomography data in 4 patients

Cited by 17 publications

References 12 publications

Uncommon glial tumors

Uncommon glial tumors

Lhermitte-Duclos disease presenting with positron emission tomography-magnetic resonance fusion imaging: a case report

Gangliocytoma of the medulla oblongata demonstrating high tracer uptake on positron emission tomography

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