18F-FDG PET/CT scan standardised uptake value (SUV) score for diagnosis, staging and monitoring malignancy in spinal melanotic schwannoma

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Abstract

Melanotic schwannoma (MS) is a rare nerve sheath neuroectodermal neoplasm. We highlight the use of F18-fluorodeoxyglucose positive emission tomography/computed tomography (18F-FDG PET/CT) standardised uptake value (SUV) results in the diagnosis, staging and monitoring of spinal MS. A 58-year-old female patient had a 6-month history of left leg pain (S1) and no skin lesions. Magnetic resonance imaging reported a possible schwannoma with CT-guided biopsy, indicating a metastatic malignant melanoma. 18F-FDG PET/CT scan revealed only sacral destruction and an SUV score of 3.6. Histopathology results confirmed a malignant melanotic peripheral nerve sheath tumour (schwannoma). In MS, the 18F-FDG PET/CT scan SUV cut-off point can be used to distinguish between benign and malignant lesions, whereas (SUV _max) can predict the histologic response and therefore useful as a ‘screening test’. Our case highlights the increased uptake on PET/CT by melanocytic variant of neurogenic tumours and clinicians need to be aware of this.

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Most cited references 15

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Quantitative F18-fluorodeoxyglucose positron emission tomography accurately characterizes peripheral nerve sheath tumors as malignant or benign.

Fritz C Eilber, David Elashoff, Bruce Auerbach … (2010)

Correct pretreatment classification is critical for optimizing diagnosis and treatment of patients with peripheral nerve sheath tumors (PNSTs). The aim of this study was to evaluate whether F18-fluorodeoxyglucose positron emission tomography (FDG PET) can differentiate malignant (MPNST) from benign PNSTs. Thirty-four adult patients presenting with PNST who underwent a presurgical FDG PET/computed tomography (CT) scan between February 2005 and November 2008 were included in the study. Tumors were characterized histologically, by FDG maximum standardized uptake value (SUV(max) [g/mL]), and by CT size (tumor maximal diameter [cm]). The accuracy of FDG PET for differentiating MPNSTs from benign PNSTs (neurofibroma and schwannoma) was evaluated by receiver operating characteristic (ROC) curve analysis. SUV(max) was measured in 34 patients with 40 tumors (MPNSTs: n = 17; neurofibromas: n = 9; schwannomas: n = 14). SUV(max) was significantly higher in MPNST compared with benign PNST (12.0 +/- 7.1 vs 3.4 +/- 1.8; P or =6.1 separated MPNSTs from BPSNTs with a sensitivity of 94% and a specificity of 91% (P < .001). By ROC curve analysis, SUV(max) reliably differentiated between benign and malignant PNSTs (area under the ROC curve of 0.97). Interestingly, the difference between MPNSTs and schwannomas was less prominent than that between MPNSTs and neurofibromas. Quantitative FDG PET imaging distinguished between MPNSTs and neurofibromas with high accuracy. In contrast, MPNSTs and schwannomas were less reliably distinguished. Given the difficulties in clinically evaluating PNST and in distinguishing benign PNST from MPNST, FDG PET imaging should be used for diagnostic intervention planning and for optimizing treatment strategies.

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Malignant melanotic schwannian tumor: a clinicopathologic, immunohistochemical, and gene expression profiling study of 40 cases, with a proposal for the reclassification of "melanotic schwannoma".

Jorge Torres-Mora, Sarah Dry, Xinmin Li … (2014)

Melanotic schwannomas (MSs), variably associated with the Carney complex, are rare tumors that usually involve spinal nerve roots but may occur in other locations. Clinicopathologic evaluation poorly predicts the behavior of MS. Fewer than 200 cases have been reported. We report a series of 40 well-characterized MSs, one of the largest series to date. The tumors were comprehensively evaluated, and clinical follow-up was obtained. Immunohistochemistry for S100 protein, Melan-A, HMB45, tyrosinase, glial fibrillary acidic protein (GFAP), EMA, SMARCB1, Ki-67 antigen, ASMTL, and the Carney complex-associated PRKAR1A gene product was performed using commercially available antibodies and the Ventana Ultraview detection system. Gene microarray study was conducted on formalin-fixed, paraffin-embedded blocks from 10 MSs and the results compared with previous data from melanoma and schwannoma. Differentially expressed genes were selected at >3-fold and P 2/10 HPF correlated with metastases (P=0.008). The clinicopathologic features of tumors with and without psammoma bodies were identical. We conclude that MSs are distinctive malignant tumors, rather than benign neoplasms with occasionally unpredictable behavior, and propose their reclassification as "malignant melanotic schwannian tumors." Loss of PRKAR1A expression suggests a link to Carney complex, even when this history is absent.

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The Role of (18)F-FDG-PET/CT in Pediatric Sarcoma.

Douglas Harrison, Marguerite Parisi, Barry L Shulkin (2017)

Considerable debate remains regarding how best to incorporate (18)F-FDG-PET/CT into clinical practice for pediatric sarcomas. Although there is a clear role for (18)F-FDG-PET/CT in staging pediatric sarcoma, the value of (18)F-FDG-PET/CT in prognostication for pediatric sarcomas remains unclear. In osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma, (18)F-FDG-PET/CT may be most useful in the identification of skeletal metastases, where the literature consistently suggests that it has improved sensitivity and specificity as compared to bone scintigraphy. The role of the imaging modality in the identification of pulmonary metastatic disease is less clear. Further controversy exists regarding the use of (18)F-FDG-PET/CT in predicting outcome. Several studies, particularly in osteosarcoma, suggest changes in the maximal standardized uptake value (SUVmax) that can predict histologic response following neoadjuvant chemotherapy as well as overall outcome. Conversely, studies are conflicting regarding the use of (18)F-FDG-PET/CT as a prognostic tool in Ewing sarcoma and rhabdomyosarcoma. The role of (18)F-FDG-PET/CT in pediatric nonrhabdomyosarcoma soft tissue sarcomas is unknown at this time. Although most studies have been small and retrospective, in certain histologic subtypes, there is a clear role for the use of this imaging modality. Additional prospective and larger studies are needed to fully determine how best to incorporate (18)F-FDG-PET/CT into treatment regimens for pediatric sarcomas in the future.

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Author and article information

Contributors

Shahnawaz Haleem:

ORCID: https://orcid.org/0000-0003-2678-9428

Mohamed H Mahmoud

Gurvinder Singh Kainth:

ORCID: https://orcid.org/0000-0001-5891-9157

Rajesh Botchu

Md Faizul Hassan

Journal

Journal ID (nlm-ta): J Surg Case Rep

Journal ID (iso-abbrev): J Surg Case Rep

Journal ID (publisher-id): jscr

Title: Journal of Surgical Case Reports

Publisher: Oxford University Press

ISSN (Electronic): 2042-8812

Publication date Collection: December 2022

Publication date (Electronic): 07 December 2022

Publication date PMC-release: 07 December 2022

Volume: 2022

Issue: 12

Electronic Location Identifier: rjac524

Affiliations

Royal Orthopaedic Hospital , Birmingham B31 2AP, UK

Neurosurgery Department, Suez Canal University , Ismailia 41522, Egypt

Royal Orthopaedic Hospital , Birmingham B31 2AP, UK

Author notes

Correspondence address. Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Northfield, Birmingham B31 2AP, UK. E-mail: shahnawaz.haleem@ 123456gmail.com

Author information

Shahnawaz Haleem https://orcid.org/0000-0003-2678-9428

Gurvinder Singh Kainth https://orcid.org/0000-0001-5891-9157

Article

Publisher ID: rjac524

DOI: 10.1093/jscr/rjac524

PMC ID: 9731614

PubMed ID: 36518642

SO-VID: 3a4be614-4281-46c2-9afa-8589fcbbfd59

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 18 July 2022

Date accepted : 26 October 2022

Page count

Pages: 3

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