Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA.
Diagn Cytopathol. 2024 Jul;52(7):387-392. doi: 10.1002/dc.25331. Epub 2024 May 7.
F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) has become the mainstay for staging and post-therapy surveillance of cancer as malignant neoplasms generally demonstrate higher FDG uptake that benign entities. However, there are certain benign lesions, most notably oncocytic tumors, that can display very high uptake and fine needle aspiration (FNA) is usually done to confirm malignancy. Therefore, it is important to recognize that benign oncocytic lesions of the head and neck may also present as FDG-avid lesions to avoid a diagnostic pitfall.
Electronic search of institutional surgical and cytopathology archives was conducted to identify cases of benign oncocytic lesions involving the head and neck region diagnosed by FNA from January 2012 to April 2022. Chart review was used to assess whether lesions were initially discovered via PET scanning.
One hundred and twenty-five cases of oncocytic lesions were identified; 12 (9%) PET positive lesions were identified in the head and neck region from patients being evaluated for metastasis or for suspicion of malignancy. Cytopathology of all 12 cases demonstrated benign oncocytic lesions; eight (67%) of these cases were consistent with Warthin tumor, one (8.3%) was a benign oncocytic lesion, and one (8.3%) was consistent wit a parathyroid adenoma. Most (58%) of the PET-positive lesions were in parotid region, two from thyroid gland (17%), one from submandibular gland (8%), one from paratracheal area (8%). The PET scan SUVs ranged from 3.3 to 19.5 g mL.
Oncocytic lesions including Warthin tumors can result in false-positive FDG uptake on PET scans. Clinicians and cytopathologists should be aware of PET-positive benign oncocytic head and neck lesions.
正电子发射断层扫描/计算机断层扫描（PET/CT）上的 F-氟脱氧葡萄糖（FDG）摄取已成为癌症分期和治疗后监测的主要手段，因为恶性肿瘤通常表现出更高的 FDG 摄取，而良性实体则不然。然而，某些良性病变，尤其是嗜酸细胞瘤，也可能表现出非常高的摄取，通常需要进行细针抽吸（FNA）以确认恶性肿瘤。因此，重要的是要认识到头颈部的良性嗜酸细胞瘤也可能表现为 FDG 摄取病变，以避免诊断陷阱。
通过电子搜索机构外科和细胞学档案，确定了 2012 年 1 月至 2022 年 4 月期间通过 FNA 诊断为头颈部良性嗜酸细胞瘤的病例。通过病历回顾评估病变是否最初通过 PET 扫描发现。
共确定了 125 例嗜酸细胞瘤病例；在头颈部区域，从评估转移或怀疑恶性肿瘤的患者中发现了 12 例（9%）PET 阳性病变。所有 12 例的细胞学均显示良性嗜酸细胞瘤；其中 8 例（67%）与沃辛瘤一致，1 例（8.3%）为良性嗜酸细胞瘤，1 例（8.3%）与甲状旁腺腺瘤一致。大多数（58%）PET 阳性病变位于腮腺区，2 例来自甲状腺（17%），1 例来自下颌下腺（8%），1 例来自气管旁区（8%）。PET 扫描 SUV 值范围为 3.3 至 19.5 g/mL。
包括沃辛瘤在内的嗜酸细胞瘤可导致 PET 扫描上出现假阳性 FDG 摄取。临床医生和细胞病理学家应意识到头颈部良性嗜酸细胞瘤的 PET 阳性病变。
