Korean J Radiol.  2015 Oct;16(5):1166-1170. 10.3348/kjr.2015.16.5.1166.

Primary Pulmonary Low-Grade Angiosarcoma Characterized by Mismatch between 18F-FDG PET and Dynamic Contrast-Enhanced CT

• Kim EY
• Lee HY
• Han J
• Choi JY

• KMID: 2160785
• DOI: http://doi.org/10.3348/kjr.2015.16.5.1166

Abstract

We report a rare case of primary pulmonary low-grade angiosarcoma on dynamic contrast-enhanced CT and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging. A 38-year-old, asymptomatic woman was hospitalized because of an abnormality on chest radiography. A dynamic contrast-enhanced chest CT showed a 1.2 cm-sized irregular-margined nodule with strong and persistent enhancement in the right lower lobe. The lesion had low metabolic activity on an 18F-FDG PET/CT scan. The patient underwent a wedge resection for the lesion, and pathology revealed a primary pulmonary low-grade angiosarcoma.

Keyword

Primary pulmonary angiosarcoma; Low-grade; 18F-FDG PET/CT; Dynamic contrast-enhanced CT

MeSH Terms

Adult
Female
Fluorodeoxyglucose F18/*chemistry
Hemangiosarcoma/*diagnosis/pathology/radiography
Humans
Ki-67 Antigen/metabolism
Lung Neoplasms/*diagnosis/pathology/radiography
Multimodal Imaging
*Positron-Emission Tomography
Radiopharmaceuticals/*chemistry
Tomography, Spiral Computed
Fluorodeoxyglucose F18
Ki-67 Antigen
Radiopharmaceuticals

Figure

• 

  Fig. 1 38-year-old woman with primary pulmonary angiosarcoma. A. Transverse lung-window (window level of -700 H and window width of 1500 H) CT image indicates 1.2 cm-sized nodule in right lower lobe with spiculated margin and needle-like projections (arrows) in periphery of nodule. B-F. Serial transverse images obtained through nodule for 180 seconds allowed dynamic enhancement curve for nodule to be plotted. Graph shows early peak enhancement and gradual loss of enhancement (washout). G. 18F-fluorodeoxyglucose positron emission tomography fused axial image shows nodule with mildly increased radiopharmaceutical uptake (arrow) with maximum standardized uptake value of 2.0. H. Gross photograph indicates soft and dark-reddish nodule with hemorrhage (arrows). I. Photomicrograph reveals highly vascular tumor with prominent freely anastomosing vascular channels, papillary growth, and endothelial tufting that was absent to minimal (× 200). J. Tumor's peripheral vasoformative features (arrows) indicate anastomosing vascular channels lined by malignant endothelium (× 100). These marginal characteristics correspond to needle-like projections in periphery of nodule seen in CT image A. K-M. Immunohistochemistry staining shows tumor cells are diffusely positive for SMA (K), and CD31 (L), and weakly positive for Ki-67 (M) (× 200). SMA = smooth muscle actin

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