Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Carcinoma on 68Ga-FAPI-04 PET

Abstract

68Ga-FAPI-04 has great potential for the detection and staging evaluation of a variety of tumors. We report a case of suspected gallbladder carcinoma that was enrolled in a prospective study of 68Ga-FAPI-04 imaging at our institution. This case was later histopathologically confirmed as xanthogranulomatous cholecystitis. This demonstrates that xanthogranulomatous cholecystitis might be disguised as gallbladder carcinoma in 68Ga-FAPI-04 imaging. Thus, we suggest that nuclear clinicians evaluating 68Ga-FAPI-04 imaging should be aware of this possibility.

FAPI Uptake in Gallbladder Is It Normal Biodistribution?

“…Here we are presenting 3 patients with GB uptake. FAPI uptakes in GB and hepatobiliary system have been reported in literature review 9–12 . Subsequent hepatobiliary ultrasound and liver function enzymes demonstrated that none of these patients had liver metastasis or other liver or GB diseases.…”

“…FAPI uptakes in GB and hepatobiliary system have been reported in literature review. [9][10][11][12] Subsequent hepatobiliary ultrasound and liver function enzymes demonstrated that none of these patients had liver metastasis or other liver or GB diseases. Case 1 presented a 60-year-old man with stage IV (according to TNM staging) lung adenocarcinoma (GB SUV max of 5.9 and SUV mean of 3.47, on the delayed phase with SUV max of 2.1 and SUV mean of 1.2 on the early ones).…”

68Ga-FAPI-04 Detected Hepatic Arteriovenous Malformation in a Patient With IgA Nephropathy

“…We speculate that the high accumulation of 68 Ga-FAPI-04 in AVM stems from the uptake by the activated fibroblasts. Meanwhile, an increasing number of case studies have reported 68 Ga-FAPI-04 uptake in various nonmalignant etiologies, including myocardial infarction, 6 IgG4-related disease, 7,8 atherosclerotic plaque, 9 xanthogranulomatous cholecystitis, 10 tuberculosis, 11 osteoarthritis, 12 ankylosing spondylitis, 13 and brucellosis 14 . This case indicates that AVM should be considered as one of the differential diagnoses for abnormal 68 Ga-FAPI-04 uptake in the liver.…”

Increased 68Ga-FAPI Activity in Primary Small Cell Neuroendocrine Carcinoma of the Gallbladder

“…[3][4][5] Gallbladder mass exhibits intense 68 Ga-FAPI uptake, including xanthogranulomatous cholecystitis and gallbladder adenocarcinoma. 6,7 The incidence of primary gallbladder small cell neuroendocrine carcinoma is 0.2% of all neuroendocrine tumors. 2,8,9 This rare neuroendocrine carcinoma has a high malignancy potential and low survival rate.…”

“…68 Ga-FAPI is a promising fibroblast-activating protein imaging agent 3–5 . Gallbladder mass exhibits intense 68 Ga-FAPI uptake, including xanthogranulomatous cholecystitis and gallbladder adenocarcinoma 6,7 . The incidence of primary gallbladder small cell neuroendocrine carcinoma is 0.2% of all neuroendocrine tumors 2,8,9 .…”