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LETTER TO EDITOR
Year : 2014  |  Volume : 29  |  Issue : 3  |  Page : 197-198  

Extra-renal malignant rhabdoid tumor of head and neck region: Characteristics of tracer uptake on FDG PET/CT in tumor with rare histology


1 Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication11-Jul-2014

Correspondence Address:
Venkatesh Rangarajan
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.136605

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How to cite this article:
Puranik AD, Purandare N, Ramadwar M, Agrawal A, Shah S, Rangarajan V. Extra-renal malignant rhabdoid tumor of head and neck region: Characteristics of tracer uptake on FDG PET/CT in tumor with rare histology. Indian J Nucl Med 2014;29:197-8

How to cite this URL:
Puranik AD, Purandare N, Ramadwar M, Agrawal A, Shah S, Rangarajan V. Extra-renal malignant rhabdoid tumor of head and neck region: Characteristics of tracer uptake on FDG PET/CT in tumor with rare histology. Indian J Nucl Med [serial online] 2014 [cited 2019 Dec 12];29:197-8. Available from: http://www.ijnm.in/text.asp?2014/29/3/197/136605

Sir,

A 40-year-old female presented with complaints of diminished vision and deviation of eyes since 15 days, with a single episode of convulsion. CT scan of head and neck showed a large mass arising from the sphenoid sinus, eroding the skull base. Endoscopy guided biopsy was done elsewhere which was suggestive of myoepithelial tumor. Since the extent of lesion made it inoperable, patient was referred to our Institution for whole body F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) study, for staging, prior to definitive radiotherapy (RT). Maximum Intensity Projection (MIP) image showed no appreciable tracer uptake in head and neck region (1a), or elsewhere in the body. Axial CT and fused PET/CT images showed an enhancing extensive soft tissue mass involving sphenoid sinus, invading the cavernous sinus and encasing bilateral carotid arteries, spreading into the clivus and skull base [Figure 1]b and c - arrow. It had a maximum Standardised Uptake value of 3.6. No discrete cervical adenopathy was noted. There was no evidence of distant metastases. Since the pattern of uptake was unlike myoepithelial tumors, which usually show intense FDG avidity, biopsy was repeated from the area with maximum SUV. Histopathology [H and E, Χ40 - [Figure 2]a showed high grade malignant tumor with tumor cells arranged in sheets, and majority showing 'rhabdoid' morphology. On immunohistochemistry (2b), loss of staining was seen for IN1 antibody, which was confirmatory for diagnosis of extra-renal rhabdoid tumor. Malignant Rhabdoid Tumor (MRT) was first described as a rare sarcomatous variants of Wilms tumour, [1] primarily because of its renal origin, in children. Though originally described as primary renal neoplasm, tumors with similar histological characteristics have been identified at extra-renal sites such as thymus, liver, central nervous system, heart, chest wall and extremities; these are termed as extra-renal malignant rhadboid tumors (ERRT). [2] Given its aggressive nature, early diagnosis and treatment becomes important. Though the diagnosis is purely based on histology and immunochemistry, as seen in our case, at the same time, it is essential to know the uptake characteristics in these rare histological variants. Oda et al., have shown that the characteristic 'rhabdoid' cells of ERRTs are also seen in certain soft tissue sarcomas such as synovial sarcomas, extraskeletal myxoid chondrosarcoma and leiomyosarcoma. [3] As per the existing literature, ERRTs demonstrate intense FDG uptake at the primary and metastatic sites. [4] However, our case is an exception wherein the tumor shows very low-grade tracer concentration. Also, the pattern of uptake is quite uniform, and cannot be appreciated on Maximum Intensity Projection (MIP) images. There are only two such reports in literature, especially in children, wherein low-grade FDG uptake is seen in ERRTs. [5],[6] Thus, ERRTs, which are rare, aggressive histological variants, are an addition to the list of tumors, which may show low grade metabolic activity on PET/CT imaging.
Figure 1: (a) MIP image shows no appreciable increased tracer uptake, whereas low-grade metabolic activity (b - arrow) is seen in enhancing ill-defined soft tissue mass in the sphenoid sinus (c - arrow), on axial PET/CT and CT images, with evidence of clival erosion suggestive of skull base extension

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Figure 2: (a) (H and E stain, ×40 magnifi cation) Extra-renal rhabdoid tumour containing sheets of malignant cells. Tumor cells contain large nuclei and prominent nucleoli. Eosinophilic cytoplasm is conspicuous imparting 'rhabdoid' phenotype to the tumor cells. (b) Immunohistochemistry for antibody to INI1; tumor cell nuclei do not show any staining while nuclei of overlying epithelium and endothelial cells lining blood vessels show positive staining (serving as internal positive control)

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   References Top

1.Weeks DA, Beckwith JB, Mierau GW, Luckey DW. Rhabdoid tumor of kidney. A report of 111 cases from the National Wilms' Tumor Study Pathology Center. Am J Surg Pathol 1989;13:439-58.  Back to cited text no. 1
    
2.Abdullah A, Patel Y, Lewis TJ, Elsamaloty H, Strobel S. Extrarenal malignant rhabdoid tumors: Radiologic findings with histopathologic correlation. Cancer Imaging 2010;10:97-101.  Back to cited text no. 2
    
3.Oda Y, Tsuneyoshi M. Extrarenal rhabdoid tumors of soft tissue: Clinicopathological and molecular genetic review and distinction from other soft-tissue sarcomas with rhabdoid features. Pathol Int 2006;56:287-95.  Back to cited text no. 3
    
4.Tam HK, Li A, Lee PS, Tse VP, Pang KK. Infantile intravesical malignant rhabdoid tumour. Hong Kong J Radiol 2013;16:e21-5.  Back to cited text no. 4
    
5.Makis W, Ciarallo A, Hickeson M. Malignant extrarenal rhabdoid tumor of the spine: Staging and evaluation of response to therapy with F-18 FDG PET/CT. Clin Nucl Med 2011;36:599-602.  Back to cited text no. 5
    
6.Howman-Giles R, McCowage G, Kellie S, Graf N. Extrarenal malignant rhabdoid tumor in childhood application of 18F-FDG PET/CT. J Pediatr Hematol Oncol 2012;34:17-21.  Back to cited text no. 6
    


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