背景:神经节细胞瘤是一种罕见的后纵隔肿瘤;含有脂肪的神经节细胞瘤很少被报道。本病例报告记录了一种棕色脂肪,后纵隔神经节神经瘤,以前没有报道过。放射学检查,特别是18F-2-氟-2-脱氧葡萄糖-正电子发射断层扫描,提示该肿瘤具有低度恶性潜能.这导致术前诊断的不确定性。
方法:一名无症状的66岁日本女性,没有明显的既往病史,被转诊评估后纵隔肿块。尽管它的规模在过去5年中没有改变,由于肿瘤内脂肪的存在和通过正电子发射断层扫描成像观察到的18F-2-氟-2-脱氧葡萄糖摄取增加,因此不能排除恶性脂肪瘤.计算机断层扫描引导的核心针活检显示成熟脂肪细胞的混合物,梭形细胞,和纤维化间质.无法明确诊断,并进行了手术切除。手术三年后,她仍然没有疾病。
结论:手术切除肿块的组织学诊断证实神经节细胞瘤在周围区域有大量的白色和棕色脂肪组织。神经节细胞和棕色脂肪组织的存在加剧了18F-2-氟-2-脱氧葡萄糖的积累,导致正电子发射断层扫描的假阳性结果。考虑到这一点,在临床或病理上不应该排除在含脂肪的神经节神经瘤,后纵隔肿瘤。
BACKGROUND: Ganglioneuroma is a rare tumor in the posterior mediastinum; fat-containing ganglioneuromas are rarely reported. The present
case report documents a brown fat-containing, posterior mediastinal ganglioneuroma, which has not been reported previously. Radiological examination, in particular 18F-2-fluoro-2-deoxyglucose-positron emission tomography, suggested that the tumor had low-grade malignant potential. This led to uncertainty at preoperative diagnosis.
METHODS: An asymptomatic 66-year-old Japanese woman with no significant past medical history was referred for the evaluation of a posterior mediastinal mass. Although its size had not changed in the past 5 years, a malignant lipomatous tumor could not be excluded due to the presence of intratumoral fat and increased 18F-2-fluoro-2-deoxyglucose uptake observed by positron emission tomography imaging. A computed tomography-guided core-needle biopsy revealed a mixture of mature adipocytes, spindle-shaped cells, and fibrotic stroma. Definite diagnosis was not possible, and surgical resection was performed. Three years after the surgery, she remains disease-free.
CONCLUSIONS: Histological diagnosis of the surgically resected mass confirmed ganglioneuroma with substantial amounts of white and brown adipose tissues in peripheral areas. The existence of both ganglion cells and brown fat tissue intensified the accumulation of 18F-2-fluoro-2-deoxyglucose, resulting in a false-positive result by positron emission tomography. Considering this, ganglioneuroma should not be excluded either clinically or pathologically in fat-containing, posterior mediastinal tumors.