The Importance of Recognizing Hibernomas as Possibly Not So Rare Pitfalls in FDG PET—A Histologically Verified Case and Literature Review
ABSTRACT
We present a glucose avid hibernoma hampering the re-staging of advanced breast cancer with FDG PET and summarize the results of the available literature. FDG PET, CT, MRI, ultrasound and histology were performed according to standardized protocols in our case. The literature search was performed on PubMed.gov. The literature search revealed 29 relevant publications starting with 2002. The high metabolic activity of hibernomas is a precarious pitfall in the staging of patients with a high pretest probability of malignancy and an increasing number of published cases indicate a possibly underestimated problem necessitating histological work-up in most cases. In our experience and in accordance with the literature unusually high uptake of a lesion and fat equivalent density in the CT should raise the suspicion for a hibernoma. The differential diagnosis between hibernomas and liposarcoma is often impossible without biopsy and histological work-up to prevent unnecessary treatment.
We present a glucose avid hibernoma hampering the re-staging of advanced breast cancer with FDG PET and summarize the results of the available literature. FDG PET, CT, MRI, ultrasound and histology were performed according to standardized protocols in our case. The literature search was performed on PubMed.gov. The literature search revealed 29 relevant publications starting with 2002. The high metabolic activity of hibernomas is a precarious pitfall in the staging of patients with a high pretest probability of malignancy and an increasing number of published cases indicate a possibly underestimated problem necessitating histological work-up in most cases. In our experience and in accordance with the literature unusually high uptake of a lesion and fat equivalent density in the CT should raise the suspicion for a hibernoma. The differential diagnosis between hibernomas and liposarcoma is often impossible without biopsy and histological work-up to prevent unnecessary treatment.
Cite this paper
T. Leitha, A. Reiner-Concin and I. Hurtl, "The Importance of Recognizing Hibernomas as Possibly Not So Rare Pitfalls in FDG PET—A Histologically Verified Case and Literature Review," Advances in Molecular Imaging, Vol. 3 No. 3, 2013, pp. 15-18. doi: 10.4236/ami.2013.33003.
T. Leitha, A. Reiner-Concin and I. Hurtl, "The Importance of Recognizing Hibernomas as Possibly Not So Rare Pitfalls in FDG PET—A Histologically Verified Case and Literature Review," Advances in Molecular Imaging, Vol. 3 No. 3, 2013, pp. 15-18. doi: 10.4236/ami.2013.33003.
References
[1] I. Dardick, “Hibernoma: A Possible Model of Brown Fat Histogenesis,” Human Pathology, Vol. 9, No. 3, 1978, pp. 321-319. doi:10.1016/S0046-8177(78)80089-6 [2] H. Sell, Y. Deshaies and D. Richard, “The Brown Adipocyte: Update on Its Metabolic Role,” The International Journal of Biochemistry & Cell Biology, Vol. 36, No. 11, 2004, pp. 2098-2104. doi:10.1016/j.biocel.2004.04.003 [3] S. Robison, A. Rapmund, C. Hemmings, M. Fulham and P. Barry, “False-Positive Diagnosis of Metastasis on Positron Emission Tomography-Computed Tomography Imaging Due to Hibernoma,” Journal of Clinical Oncology, Vol. 27, No. 6, 2009, pp. 994-995. doi:10.1200/JCO.2008.19.4977 [4] M. A. Furlong, J. C. Fanburg-Smith and M. Miettinen, “The Morphologic Spectrum of Hibernoma: A Clinicopathologic Study of 170 Cases,” The American Journal of Surgical Pathology, Vol. 25, No. 6, 2001, pp. 809-814. doi:10.1097/00000478-200106000-00014 [5] P. S. Gerard, H. Finestone, R. Lazzaro and M. D. Geller, “Intermittent FDG Uptake in Lipomatous Hypertrophy of the Interatrial Septum on Serial PET/CT Scans,” Clinical Nuclear Medicine, Vol. 33, No. 9, 2008, pp. 602-605. doi:10.1097/RLU.0b013e318181312a [6] Y. Zafar and A. R. Jazieh, “Lipomatous Hypertrophy of the Interatrial Septum Evidenced on Positron Emission Tomography in a Patient with Thyroid Cancer,” American Journal of Clinical Oncology, Vol. 29, No. 4, 2006, pp. 418-419. doi:10.1097/01.coc.0000170585.91248.b8 [7] C. M. Fan, A. J. Fischman, B. H. Kwek, S. Abbara and S. L. Aquino, “Lipomatous Hypertrophy of the Interatrial Septum: Increased Uptake on FDG PET,” American Journal of Roentgenology, Vol. 184, No. 1, 2005, pp. 339-342. doi:10.2214/ajr.184.1.01840339 [8] N. Martini, et al. “An Unusual Breast Lesion: The Ultrasonographic, Mammographic, MRI and Nuclear Medicine Findings of Mammary Hibernoma,” British Journal of Radiology, Vol. 83, No. 985, 2010, pp. 1-4. doi:10.1259/bjr/17929543 [9] J. Nishida, et al. “Clinical Findings of Hibernoma of the Buttock and Thigh: Rare Involvements and Extremely High Uptake of FDG-PET,” Medical Science Monitor, Vol. 15, No. 7, 2009, pp. CS117-CS122. [10] T. Tsuchiya, T. Osanai, A. Ishikawa, N. Kato, Y. Watanabe and T. Ogino, “Hibernomas Show Intense Accumulation of FDG Positron Emission Tomography,” Journal of Computer Assisted Tomography, Vol. 30, No. 2, 2006, pp. 333-336. doi:10.1097/00004728-200603000-00033 [11] R. Suzuki, et al. “PET Evaluation of Fatty Tumors in the Extremity: Possibility of Using the Standardized Uptake Value (SUV) to Differentiate Benign Tumors from Liposarcoma,” Annals of Nuclear Medicine, Vol. 19, No. 8, 2005, pp. 661-670. doi:10.1007/BF02985114 [12] C. S. Smith, J. Teruya-Feldstein, J. F. Caravelli and H. W. Yeung, “False-Positive Findings on 18F-FDG PET/CT: Differentiation of Hibernoma and Malignant Fatty Tumor on the Basis of Fluctuating Standardized Uptake Values,” American Journal of Roentgenology, Vol. 190, No. 4, 2008, pp. 1091-1096. doi:10.2214/AJR.07.3061 [13] M. J. Burdick, P. R. Jolles, M. M. Grimes and D. A. Henry, “Mediastinal Hibernoma Simulates a Malignant Lesion on Dual Time Point FDG Imaging,” Lung Cancer, Vol. 59, No. 3, 2008, pp. 391-394. doi:10.1016/j.lungcan.2007.08.020 [14] L. W. Bancroft, M. J. Kransdorf, J. J. Peterson and M. I. O’Connor, “Benign Fatty Tumors: Classification, Clinical Course, Imaging Appearance, and Treatment,” Skeletal Radiology, Vol. 35, No. 10, 2006, pp. 719-733. doi:10.1007/s00256-006-0189-y [15] C. M. Park, J. M. Goo, H. J. Lee, M. A. Kim, C. H. Lee and M. J. Kang, “Tumors in the Tracheobronchial Tree: CT and FDG PET Features,” RadioGraphics, Vol. 29, No. 1, 2009, pp. 55-71. doi:10.1148/rg.291085126
[1] I. Dardick, “Hibernoma: A Possible Model of Brown Fat Histogenesis,” Human Pathology, Vol. 9, No. 3, 1978, pp. 321-319. doi:10.1016/S0046-8177(78)80089-6 [2] H. Sell, Y. Deshaies and D. Richard, “The Brown Adipocyte: Update on Its Metabolic Role,” The International Journal of Biochemistry & Cell Biology, Vol. 36, No. 11, 2004, pp. 2098-2104. doi:10.1016/j.biocel.2004.04.003 [3] S. Robison, A. Rapmund, C. Hemmings, M. Fulham and P. Barry, “False-Positive Diagnosis of Metastasis on Positron Emission Tomography-Computed Tomography Imaging Due to Hibernoma,” Journal of Clinical Oncology, Vol. 27, No. 6, 2009, pp. 994-995. doi:10.1200/JCO.2008.19.4977 [4] M. A. Furlong, J. C. Fanburg-Smith and M. Miettinen, “The Morphologic Spectrum of Hibernoma: A Clinicopathologic Study of 170 Cases,” The American Journal of Surgical Pathology, Vol. 25, No. 6, 2001, pp. 809-814. doi:10.1097/00000478-200106000-00014 [5] P. S. Gerard, H. Finestone, R. Lazzaro and M. D. Geller, “Intermittent FDG Uptake in Lipomatous Hypertrophy of the Interatrial Septum on Serial PET/CT Scans,” Clinical Nuclear Medicine, Vol. 33, No. 9, 2008, pp. 602-605. doi:10.1097/RLU.0b013e318181312a [6] Y. Zafar and A. R. Jazieh, “Lipomatous Hypertrophy of the Interatrial Septum Evidenced on Positron Emission Tomography in a Patient with Thyroid Cancer,” American Journal of Clinical Oncology, Vol. 29, No. 4, 2006, pp. 418-419. doi:10.1097/01.coc.0000170585.91248.b8 [7] C. M. Fan, A. J. Fischman, B. H. Kwek, S. Abbara and S. L. Aquino, “Lipomatous Hypertrophy of the Interatrial Septum: Increased Uptake on FDG PET,” American Journal of Roentgenology, Vol. 184, No. 1, 2005, pp. 339-342. doi:10.2214/ajr.184.1.01840339 [8] N. Martini, et al. “An Unusual Breast Lesion: The Ultrasonographic, Mammographic, MRI and Nuclear Medicine Findings of Mammary Hibernoma,” British Journal of Radiology, Vol. 83, No. 985, 2010, pp. 1-4. doi:10.1259/bjr/17929543 [9] J. Nishida, et al. “Clinical Findings of Hibernoma of the Buttock and Thigh: Rare Involvements and Extremely High Uptake of FDG-PET,” Medical Science Monitor, Vol. 15, No. 7, 2009, pp. CS117-CS122. [10] T. Tsuchiya, T. Osanai, A. Ishikawa, N. Kato, Y. Watanabe and T. Ogino, “Hibernomas Show Intense Accumulation of FDG Positron Emission Tomography,” Journal of Computer Assisted Tomography, Vol. 30, No. 2, 2006, pp. 333-336. doi:10.1097/00004728-200603000-00033 [11] R. Suzuki, et al. “PET Evaluation of Fatty Tumors in the Extremity: Possibility of Using the Standardized Uptake Value (SUV) to Differentiate Benign Tumors from Liposarcoma,” Annals of Nuclear Medicine, Vol. 19, No. 8, 2005, pp. 661-670. doi:10.1007/BF02985114 [12] C. S. Smith, J. Teruya-Feldstein, J. F. Caravelli and H. W. Yeung, “False-Positive Findings on 18F-FDG PET/CT: Differentiation of Hibernoma and Malignant Fatty Tumor on the Basis of Fluctuating Standardized Uptake Values,” American Journal of Roentgenology, Vol. 190, No. 4, 2008, pp. 1091-1096. doi:10.2214/AJR.07.3061 [13] M. J. Burdick, P. R. Jolles, M. M. Grimes and D. A. Henry, “Mediastinal Hibernoma Simulates a Malignant Lesion on Dual Time Point FDG Imaging,” Lung Cancer, Vol. 59, No. 3, 2008, pp. 391-394. doi:10.1016/j.lungcan.2007.08.020 [14] L. W. Bancroft, M. J. Kransdorf, J. J. Peterson and M. I. O’Connor, “Benign Fatty Tumors: Classification, Clinical Course, Imaging Appearance, and Treatment,” Skeletal Radiology, Vol. 35, No. 10, 2006, pp. 719-733. doi:10.1007/s00256-006-0189-y [15] C. M. Park, J. M. Goo, H. J. Lee, M. A. Kim, C. H. Lee and M. J. Kang, “Tumors in the Tracheobronchial Tree: CT and FDG PET Features,” RadioGraphics, Vol. 29, No. 1, 2009, pp. 55-71. doi:10.1148/rg.291085126