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

Abstract

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.

Magnetic resonance characteristics of adult-onset Lhermitte-Duclos disease: An indicator for active cancer surveillance?

“…Furthermore, all these 5 patients were women, suggesting a female preponderance in the incidence of LDD coexisting with CD, which is in concordance with previous findings (n=53; 39 women and 14 men) (3,(8)(9)(10). It is of great significance and clinical relevance to acknowledge the association between LDD and CD, although further data collection is required at the molecular level to elucidate the nature of this association.…”

“…Accumulating evidence indicates that aLDD is pathognomonic for CD (2)(3)(4)(5), which is a multiple hamartoma syndrome with an increased risk for benign and malignant tumors of the thyroid gland, breast, endometrium and other organs (5)(6)(7). To the best of our knowledge, ~250 LDD cases have been reported in the medical literature to date, 53 of which were associated with CD (3,(8)(9)(10).…”

18F-Choline PET/CT Pitfalls in Image Interpretation

“…1Y3 Beyond FDG, 18 F-choline is a PET tracer with promising results in the detection and evaluation of somatic cancers with low glucose metabolism, such as hepatocellular cancer 4 and adenocarcinoma in situ, formerly known as bronchioloalveolar or bronchoalveolar carcinoma. 5 Being a component of phosphatidylcholine, an important element of the cell membrane, this tracer could be versatile and feasible in the management of some malignant conditions.…”

“…In fact, the biosynthesis of the cell membrane is particularly increased in PC and other tumors, and it induces higher uptake of choline. Consequentially, the in vivo uptake of choline (labeled with 18 F or 11 C) provides important information about the extension and growth of the tumor. 2 It is important to underline that, considering the pharmacologic features and properties of choline, the uptake of the tracer can occur in physiologic or benign conditions that incorporate cell membrane synthesis and in other malignancies.…”

“…2 It is important to underline that, considering the pharmacologic features and properties of choline, the uptake of the tracer can occur in physiologic or benign conditions that incorporate cell membrane synthesis and in other malignancies. In fact, despite the prominent role acquired by 18 F-choline PET/CT in the management of PC patients and its capability in detecting other tumors, few studies have focused their attention on the possibility to verify how and when physiologic processes or benign lesions can accumulate 18 F-choline and may be confused with malignant neoplasms. On the other hand, it is important to consider that the uptake of 18 F-choline can occur in malignant tumors other than PC.…”