Unexpected Slight Fluorodeoxyglucose-Uptake on Positron Emission Tomography in a Pulmonary Hamartoma

Himpe, Ulrike; Deroose, Christophe M.; Leyn, Paul De; Verbeken, Eric; Vansteenkiste, Johan

doi:10.1097/jto.0b013e31818e0e02

Cited by 12 publications

(8 citation statements)

References 5 publications

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“…In addition, it was impossible to identify numerous vessels in the mass. Moreover, fluorodeoxyglucose (FDG) positron emission tomography (PET) is useful for the differentiation of pulmonary mass lesions [20]. However, some reports on hamartomas describe the difficulty with differentiation from malignant tumors when a slight abnormal accumulation of FDG is recognized.…”

Section: Discussionmentioning

confidence: 99%

Death Related to a Congenital Vascular Anomaly of Pulmonary Hamartoma Type: Malpractice or Tragic Fatality?

Marrone

Cazzato

et al. 2021

Medicina

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In forensic pathology, apparently straightforward cases can often hide rarities that, if not correctly interpreted, can alter the results of the entire investigation, leading to misinterpretations. This occurs when the investigation is conducted to assess medical malpractice. An unexpected death, with no known apparent cause, is often linked to an underlying disease process of unclear etiological origin whose nature can, unfortunately, be properly investigated only post-mortem. This presentation shows a case study, in which it was possible to reconduct the death of a patient to a natural pathology and not to medical treatment. Here, the authors illustrate a case with a hamartoma developed in chronic inflammatory conditions (bronchiectasis) that was difficult to differentiate from lung cancer due to the inability to perform specific instrumental examinations. The hamartoma, usually benign and identifiable by standard instrumental investigations, in this case, led to the patient’s death precisely during the execution of a bronchoscopy. However, in the absence of a certain cause of death, public opinion unanimously attributes a patient’s disease to medical error. Indeed, a routine practice such as bronchoscopy should not cause death and consequently, the doctor must have made a mistake. Fortunately, the autopsy not only demonstrated the origin of the bleeding but also unveiled the reason for this, as rare congenital lung disease. Fate, one might say.

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Section: Discussionmentioning

confidence: 99%

Death Related to a Congenital Vascular Anomaly of Pulmonary Hamartoma Type: Malpractice or Tragic Fatality?

Marrone

Cazzato

et al. 2021

Medicina

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“…All of these lesions showed FDG uptake, therefore none was considered typically benign, and we proceeded to surgical resection in all cases. For the lesions with a lower uptake, a diagnosis of hamartoma was considered unlikely, because the FDG uptake is exceptional for hamartomas [21,22]; infections or inflammatory lesions remained in the differential diagnosis but they were considered less probable than carcinoids after a careful examination of the patient. Regarding the lesions with a higher uptake, a diagnosis of lung carcinoma, particularly a low-grade adenocarcinoma, was taken into account; in these latter cases, a further unconfirmed suspicion of carcinoid would not have affected the adequacy of the surgical indication.…”

Section: Discussionmentioning

confidence: 99%

Integrated FDG-PET/CT imaging is useful in the approach to carcinoid tumors of the lung

Stefani

Franceschetto

Nesci

et al. 2013

J Cardiothorac Surg

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BackgroundCarcinoids enter the differential diagnosis of the solitary pulmonary nodule. Bronchial carcinoids have been traditionally considered as FDG-PET negative but recent studies have found an higher sensitivity of integrated FDG-PET/CT for the detection of these neoplasms. The purpose of this study was to investigate the value of integrated FDG-PET/CT for the evaluation of SPN suspected to be carcinoids.MethodsAll patients with pathologically proven bronchial carcinoids who had FDG-PET/CT scans between 2006 and 2012 have been retrospectively reviewed. PET/CT was performed with the same scanner and the same technique for all patients. The following data were retrieved: age, sex CT findings (side, location, size, shape, margins), SUVmax, type of operation, pathological findings (size and number of mitoses). Regarding PET findings, only SUVmax was considered, whereas the visual assessment was not undertaken. Carcinoids were defined as typical and atypical and as central and peripheral. The long-term follow-up was also recorded. The SUVmax was compared with the other clinical, radiological and pathological variables to find any significant difference or correlation.ResultsTwenty-five patients were retrieved, 24 typical and one atypical carcinoid, 21 peripheral and 4 central lesions. The mean diameter on CT-scan was 25.3 mm and the clinical size correlated well with the pathological size. Sixty percent of the tumors were ovoid and 68% had smooth margins. The mean SUVmax was 3.6 (range 1.4-12.9). All the lesions were completely resected. The regression analysis showed a direct correlation between the SUVmax and the tumor size (p = 0.004). No further correlations were found between the SUVmax and the other variables. None of the patients had recurrent disease or died during the follow-up.ConclusionsOur study showed that FDG-PET/CT might be a useful tool in the evaluation of SPNs suspected to be bronchial carcinoids. When a solitary pulmonary nodule shows an ovoid/round shape and smooth margins on the CT scan and demonstrates an FDG uptake higher than that of the normal lung and with a SUVmax value >1-1.5, a carcinoid should be suspected. If benign lesions can be presumably excluded, surgical resection or at least a biopsy of the lesion is recommended.

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“…In our case, because there was no abnormal accumulation of FDG, we were able to judge the lesion to very likely be a benign tumor. However, some reports on hamartomas describe difficulty with differentiation from malignant tumors when slight abnormal accumulation of FDG is recognized [10]. …”

Section: Discussionmentioning

confidence: 99%

A Case of Pulmonary Hamartoma Showing Rapid Growth

Itoga

Kobayashi

Takeda

et al. 2013

Case Reports in Medicine

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A 65-year-old man was admitted for detailed examination of a growing nodular shadow in the left lung. The nodular shadow was initially detected in a routine chest X-ray check-up in March 2012 that warranted regular chest X-ray follow-up. The nodular shadow increased in size from 12 × 15 mm to 15 × 20 mm within five months. The calculated tumor doubling time (TDT) in our case was approximately 132.2 days. A malignant tumor was strongly suspected based on the rapid growth, and tumorectomy was thus performed. Cartilaginous tissue accounted for most of the pathological specimen, but a small amount of an epithelial component was observed histologically, and we diagnosed a hamartoma. Hamartoma generally shows slow annual growth, but it is important to recognize that rapid enlargement occurs in some cases.

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Unexpected Slight Fluorodeoxyglucose-Uptake on Positron Emission Tomography in a Pulmonary Hamartoma

Cited by 12 publications

References 5 publications

Death Related to a Congenital Vascular Anomaly of Pulmonary Hamartoma Type: Malpractice or Tragic Fatality?

Death Related to a Congenital Vascular Anomaly of Pulmonary Hamartoma Type: Malpractice or Tragic Fatality?

Integrated FDG-PET/CT imaging is useful in the approach to carcinoid tumors of the lung

A Case of Pulmonary Hamartoma Showing Rapid Growth

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