INTERESTING IMAGE
Intestinal Pork Tapeworm Disease Mimicking Lymphoma on PET/CT Imaging Lei Jiang, MD, PhD,* Hanxing Tong, MD,Þ Hui Tan, MD,* Lei Han, MD,* and Hongcheng Shi, MD, PhD* Abstract: A 17-year-old girl with abdominal pain for 3 months underwent 18 F-FDG PET to evaluate possible malignancy due to unexplained ascites detected by ultrasound. The images demonstrated multiple foci of abnormally increased 18F-FDG activity in the lymphadenopathy from the neck to the abdomen and in the thickened intestinal wall. In addition, abnormal activity was noted in the pharynx and skeletons. Cysticercosis was confirmed pathologically. Key Words: pork tapeworm disease, FDG, PET/CT (Clin Nucl Med 2014;39: 842Y844)
Received for publication January 8, 2014; revision accepted May 9, 2014. From the Departments of *Nuclear Medicine and †General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. Lei Jiang and Hanxing Tong contributed equally to this work. Conflicts of interest and sources of funding: none declared. Reprints: Hongcheng Shi, MD, PhD, Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0363-9762/14/3909Y0842
842
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REFERENCES 1. Wilkinson MD, Fulham MJ, McCaughan BC, et al. Invasive aspergillosis mimicking stage IIIA nonYsmall-cell lung cancer on FDG positron emission tomography. Clin Nucl Med. 2003;28:234Y235. 2. Yapar AF, Reyhan M, Canpolat ET. Ameboma mimicking lung cancer on FDG PET/CT. Clin Nucl Med. 2010;35:55Y56. 3. Joshi P, Lele V, Mahajan P. Lymphadenopathy resulting from acute toxoplasmosis mimicking relapse of non-Hodgkin’s lymphoma on fluorodeoxyglucose positron emission tomography/computed tomography. J Cancer Res Ther. 2012;8:126Y128. 4. Niccoli Asabella A, Altini C, Pisani AR, et al. 18F-FDG PET/CT metabolic activity assessment in infective and neoplastic diseases: a patient with systemic hydatidosis and concomitant Burkitt lymphoma. Clin Nucl Med. 2013;38: 546Y549. 5. Hakan D, Metin H, Selda Y, et al. A doughnut sign of a hydatid cyst of the liver on F-18 FDG PET/CT. Clin Nucl Med. 2008;33:876Y877. 6. Ivanova K, Glatz K, Zippelius A, et al. Acute toxoplasmosis mimicking melanoma metastases: review of conditions causing false-positive results on (18)F-FDG PET/CT. Dermatology. 2012;225:349Y353. 7. Caoduro C, Porot C, Vuitton DA, et al. The role of delayed 18F-FDG PET imaging in the follow-up of patients with alveolar echinococcosis. J Nucl Med. 2013;54:358Y363. 8. Dong A, Zuo C, Wang Y, et al. Organized urachal abscess mimicking urachal carcinoma on FDG PET/CT. Clin Nucl Med. 2014;39:71Y73. 9. Basu S, Chryssikos T, Moghadam-Kia S, et al. Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med. 2009;39:36Y51. 10. Kumar R, Basu S, Torigian D, et al. Role of modern imaging techniques for diagnosis of infection in the era of 18F-fluorodeoxyglucose positron emission tomography. Clin Microbiol Rev. 2008;21:209Y224. 11. Zhuang H, Yu JQ, Alavi A. Applications of fluorodeoxyglucose-PET imaging in the detection of infection and inflammation and other benign disorders. Radiol Clin North Am. 2005;43:121Y134.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Pork Tapeworm Disease Mimicking Lymphoma on PET/CT
FIGURE 1. 18F-FDG PET/CT was performed on a 17-year-old girl to determine the cause of unexplained ascites. The CT images showed thickening of the bowel (A), where increased FDG activity was also observed on PET (B) and fusion (C) images. On coronal views of CT (D), PET (E), and fusion (F) images, increased FDG uptake was also noted in the abdominal lymph nodes, which could also be well visualized on axial image (G). In addition, there was abnormal activity in the hepatic hilar (H), bilateral necks, axillas, and the left supraclavicular region (I). Symmetric FDG uptake by nasopharynx/oropharynx and diffuse FDG uptake by the bones were also seen.
* 2014 Lippincott Williams & Wilkins
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Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Clinical Nuclear Medicine
Jiang et al
& Volume 39, Number 9, September 2014
FIGURE 2. The enteroscopy displayed a strip worm in the proximal jejunum (arrows), which was removed for biopsy. No obvious intestinal mass and villi change was observed. After analysis of the blood sample and pathological specimen from jejunum biopsy, a diagnosis of cysticercosis was made.
FIGURE 3. A, Pathological examination of nasopharyngeal (hematoxylin and eosin staining, original magnification 200) showed a diffuse infiltration of inflammation cells. B, Moreover, the histological result of bone marrow (hematoxylin and eosin staining, original magnification 200), displayed that only eosinophils were noted increasing obviously, mostly based on middle-late immature eosinophils, which consisted of increasing eosinophils in peripheral blood and suggestive of parasite infection. 18 F-FDG PET/CT has been effective to evaluate many types of malignancies. It is reported that different infection or inflammation can mimic malignant lesions on PET/CT.1Y11 However, the possibility of false-positive results caused by parasite infection, such as the pork tapeworm disease we presented, is still underestimated by many physicians. 844
www.nuclearmed.com
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Intestinal Pork Tapeworm Disease Mimicking Lymphoma on PET/CT Imaging Lei Jiang, MD, PhD,* Hanxing Tong, MD,Þ Hui Tan, MD,* Lei Han, MD,* and Hongcheng Shi, MD, PhD* Abstract: A 17-year-old girl with abdominal pain for 3 months underwent 18 F-FDG PET to evaluate possible malignancy due to unexplained ascites detected by ultrasound. The images demonstrated multiple foci of abnormally increased 18F-FDG activity in the lymphadenopathy from the neck to the abdomen and in the thickened intestinal wall. In addition, abnormal activity was noted in the pharynx and skeletons. Cysticercosis was confirmed pathologically. Key Words: pork tapeworm disease, FDG, PET/CT (Clin Nucl Med 2014;39: 842Y844)
Received for publication January 8, 2014; revision accepted May 9, 2014. From the Departments of *Nuclear Medicine and †General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. Lei Jiang and Hanxing Tong contributed equally to this work. Conflicts of interest and sources of funding: none declared. Reprints: Hongcheng Shi, MD, PhD, Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China. E-mail: [email protected]. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0363-9762/14/3909Y0842
842
www.nuclearmed.com
REFERENCES 1. Wilkinson MD, Fulham MJ, McCaughan BC, et al. Invasive aspergillosis mimicking stage IIIA nonYsmall-cell lung cancer on FDG positron emission tomography. Clin Nucl Med. 2003;28:234Y235. 2. Yapar AF, Reyhan M, Canpolat ET. Ameboma mimicking lung cancer on FDG PET/CT. Clin Nucl Med. 2010;35:55Y56. 3. Joshi P, Lele V, Mahajan P. Lymphadenopathy resulting from acute toxoplasmosis mimicking relapse of non-Hodgkin’s lymphoma on fluorodeoxyglucose positron emission tomography/computed tomography. J Cancer Res Ther. 2012;8:126Y128. 4. Niccoli Asabella A, Altini C, Pisani AR, et al. 18F-FDG PET/CT metabolic activity assessment in infective and neoplastic diseases: a patient with systemic hydatidosis and concomitant Burkitt lymphoma. Clin Nucl Med. 2013;38: 546Y549. 5. Hakan D, Metin H, Selda Y, et al. A doughnut sign of a hydatid cyst of the liver on F-18 FDG PET/CT. Clin Nucl Med. 2008;33:876Y877. 6. Ivanova K, Glatz K, Zippelius A, et al. Acute toxoplasmosis mimicking melanoma metastases: review of conditions causing false-positive results on (18)F-FDG PET/CT. Dermatology. 2012;225:349Y353. 7. Caoduro C, Porot C, Vuitton DA, et al. The role of delayed 18F-FDG PET imaging in the follow-up of patients with alveolar echinococcosis. J Nucl Med. 2013;54:358Y363. 8. Dong A, Zuo C, Wang Y, et al. Organized urachal abscess mimicking urachal carcinoma on FDG PET/CT. Clin Nucl Med. 2014;39:71Y73. 9. Basu S, Chryssikos T, Moghadam-Kia S, et al. Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med. 2009;39:36Y51. 10. Kumar R, Basu S, Torigian D, et al. Role of modern imaging techniques for diagnosis of infection in the era of 18F-fluorodeoxyglucose positron emission tomography. Clin Microbiol Rev. 2008;21:209Y224. 11. Zhuang H, Yu JQ, Alavi A. Applications of fluorodeoxyglucose-PET imaging in the detection of infection and inflammation and other benign disorders. Radiol Clin North Am. 2005;43:121Y134.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Pork Tapeworm Disease Mimicking Lymphoma on PET/CT
FIGURE 1. 18F-FDG PET/CT was performed on a 17-year-old girl to determine the cause of unexplained ascites. The CT images showed thickening of the bowel (A), where increased FDG activity was also observed on PET (B) and fusion (C) images. On coronal views of CT (D), PET (E), and fusion (F) images, increased FDG uptake was also noted in the abdominal lymph nodes, which could also be well visualized on axial image (G). In addition, there was abnormal activity in the hepatic hilar (H), bilateral necks, axillas, and the left supraclavicular region (I). Symmetric FDG uptake by nasopharynx/oropharynx and diffuse FDG uptake by the bones were also seen.
* 2014 Lippincott Williams & Wilkins
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
843
Clinical Nuclear Medicine
Jiang et al
& Volume 39, Number 9, September 2014
FIGURE 2. The enteroscopy displayed a strip worm in the proximal jejunum (arrows), which was removed for biopsy. No obvious intestinal mass and villi change was observed. After analysis of the blood sample and pathological specimen from jejunum biopsy, a diagnosis of cysticercosis was made.
FIGURE 3. A, Pathological examination of nasopharyngeal (hematoxylin and eosin staining, original magnification 200) showed a diffuse infiltration of inflammation cells. B, Moreover, the histological result of bone marrow (hematoxylin and eosin staining, original magnification 200), displayed that only eosinophils were noted increasing obviously, mostly based on middle-late immature eosinophils, which consisted of increasing eosinophils in peripheral blood and suggestive of parasite infection. 18 F-FDG PET/CT has been effective to evaluate many types of malignancies. It is reported that different infection or inflammation can mimic malignant lesions on PET/CT.1Y11 However, the possibility of false-positive results caused by parasite infection, such as the pork tapeworm disease we presented, is still underestimated by many physicians. 844
www.nuclearmed.com
* 2014 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
