Author/Authors :
Harashima ، Kazutaka Department of Diagnostic Imaging, Department of Diagnostic and Interventional Radiology - Graduate School of Medicine, Hokkaido University Hospital - Hokkaido University , Watanabe ، Shiro Department of Diagnostic Imaging, Department of Nuclear Medicine - Graduate School of Medicine, Hokkaido University Hospital - Hokkaido University , Okazaki ، Nanase Department of Surgical Pathology - Hokkaido University Hospital , Endo ، Daisuke Department of Obstetrics and Gynecology - Graduate School of Medicine - Hokkaido University , Uchiyama ، Yuko Department of Diagnostic Imaging, Department of Nuclear Medicine - Graduate School of Medicine, Hokkaido University Hospital - Hokkaido University , Kato ، Fumi Department of Diagnostic Imaging, Department of Diagnostic and Interventional Radiology - Graduate School of Medicine, Hokkaido University Hospital - Hokkaido University , Hirata ، Kenji Department of Diagnostic Imaging, Department of Nuclear Medicine - Graduate School of Medicine, Hokkaido University Hospital - Hokkaido University , Kudo ، Kohsuke Department of Diagnostic Imaging, Department of Diagnostic and Interventional Radiology, Global Station for Quantum Medical Science and Engineering - Graduate School of Medicine, Hokkaido University Hospital, Global Institution for Collaborative Research and Education - Hokkaido University
Abstract :
Although 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is an established method for the staging of malignancies, benign lesions (e.g, active inflammatory lesions) often show increased metabolic activity. Herpes zoster is the clinical manifestation of the activation and replication of dormant varicella-zoster virus (VZV) in individuals with decreased cell-mediated immunity. Although the diagnosis of herpes zoster is clinical, it is sometimes observed incidentally during imaging for another disease. We describe the case of a 67-year-old Japanese female patient diagnosed with cervical cancer in whom FDG-PET/CT revealed herpes zoster manifestations: hypermetabolic cutaneous lesions in the buttock and pelvic lymph node involvement. The resected lymph nodes showed no malignant lesions but revealed lymphoid follicle formation, probably related to viral infection. There has been no report comparing FDG-PET findings of lymph nodes with histologic findings; the present findings are compatible with a clinically VZV-induced inflammatory reaction in regional lymph nodes, which increased FDG accumulation. Active infection with VZV displays increased FDG uptake in regional lymph nodes and may lead to incorrect malignant disease management in oncology. Misdiagnoses can be avoided by a careful interpretation by experienced nuclear medicine physicians as well as proper clinical evaluation.
Keywords :
varicella zoster , Herpes zoster , FDG , PET , Cervical Cancer
