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Year : 2021  |  Volume : 36  |  Issue : 4  |  Page : 453-454  

Granulomatous lung nodule mimicking as metastasis on F18 fluorodeoxyglucose positron emission tomography/computed tomography in a case of adrenocortical carcinoma


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

Date of Submission08-Apr-2021
Date of Acceptance09-Jun-2021
Date of Web Publication15-Dec-2021

Correspondence Address:
Dr. Archi Agrawal
Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, E. Borges Road, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.ijnm_48_21

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   Abstract 


A variety of fungal pulmonary infections can produce radiologic findings that mimic malignancy. Distinguishing these infectious lesions from malignancy remains challenging for physicians. We describe one such case where fungal lung nodule mimicked metastasis on fluorodeoxyglucose positron emission tomography/computed tomography scan.

Keywords: Fluorodeoxyglucose positron emission tomography-computed tomography, fungal granuloma, lung nodule


How to cite this article:
Gosavi A, Agrawal A, Menon S, Purandare N, Shah S, Puranik A, Rangarajan V. Granulomatous lung nodule mimicking as metastasis on F18 fluorodeoxyglucose positron emission tomography/computed tomography in a case of adrenocortical carcinoma. Indian J Nucl Med 2021;36:453-4

How to cite this URL:
Gosavi A, Agrawal A, Menon S, Purandare N, Shah S, Puranik A, Rangarajan V. Granulomatous lung nodule mimicking as metastasis on F18 fluorodeoxyglucose positron emission tomography/computed tomography in a case of adrenocortical carcinoma. Indian J Nucl Med [serial online] 2021 [cited 2022 Jan 17];36:453-4. Available from: https://www.ijnm.in/text.asp?2021/36/4/453/332619




   Explaination Top


A 25-year-old male, presented with complaints of abdominal pain, fever, and vomiting. Computed tomography (CT) scan revealed 6 cm sized left adrenal mass, underwent left adrenal mass excision, histopathology revealed adrenocortical carcinoma. Postoperative 18F Fluorodeoxyglucose positron emission tomography (FDG PET/ CT) revealed focal increased FDG uptake in the right lung, upper lobe nodule and on axial images, with SUV max-7.08 [Figure 1]. The imaging findings were suspicious for a metastatic nodule. Video-assisted-thoracoscopic metastatectomy of the nodule with completion adrenalectomy was done. Histopathology from lung nodules revealed necrotic granulomatous inflammation with giant cells suggestive of fungal infection with no evidence of malignancy. Special stain photomicrographs revealed yeast-like organisms suggestive of Cryptococcus [Figure 1d]. The infectious agents that mimic malignancy or metastases in the lung include bacteria (Fusobacterium, Pseudomonas, Streptococcus), mycobacterium (Mycobacterium tuberculosis, Mycobacterium kansasii), parasites (Dirofilaria), fungi, and rarely, viruses (Cytomegalovirus).[1] Fungal infections that mimic malignancy include coccidioidomycosis, histoplasmosis, aspergillosis, North American blastomycosis, and cryptococcosis.[2] An SUV of 2.5 has been traditionally used as a cut-off value for differentiating malignancy from infection; but in pulmonary cryptococcosis, the SUV may vary widely, from mild to marked uptake and thus these findings indicate that FDG PET/CT is of limited value in differentiating cryptococcosis from malignancy.[3] In conclusion, such FDG-avid lung nodules pose quite a diagnostic challenge in a known case of malignancy and thus should always be correlated with a proper histopathological and microbiological evaluation.
Figure 1: Focal increased FDG uptake in the right lung seen on MIP (Image a) and well defined, peripheral, solitary and round shaped nodule is seen on axial fused PET/CT and CT images (Image b and c). Histopathology slides confirmed yeast-like organisms suggestive of Cryptococcus (Image d)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Schweigert M, Dubecz A, Beron M, Ofner D, Stein HJ. Pulmonary infections imitating lung cancer: Clinical presentation and therapeutical approach. Ir J Med Sci 2013;182:73-80.  Back to cited text no. 1
    
2.
Rolston KV, Rodriguez S, Dholakia N, Whimbey E, Raad I. Pulmonary infections mimicking cancer: A retrospective, three-year review. Support Care Cancer 1997;5:90-3.  Back to cited text no. 2
    
3.
Huang CJ, You DL, Lee PI, Hsu LH, Liu CC, Shih CS, et al. Characteristics of integrated 18F-FDG PET/CT in pulmonary cryptococcosis. Acta Radiol 2009;50:374-8.  Back to cited text no. 3
    


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