18F-FDG PET/CT in lymphangiosarcoma: A case report and review of literature

Document Type : Case report

Author

Department of Nuclear medicine, Dr Rajendra Prasad government medical college, India

Abstract

Objective(s): Lymphangiosarcoma is a rare tumor that affects the upper limbs of patients who have undergone breast cancer surgery, including axillary dissection, followed by radiation therapy (RT) to the axilla and has a poor prognosis. 18F-FDG PET/CT may enable the earlier detection of malignant transformation in a setting of chronic lymphedema and help evaluate the extent and staging of the tumor, allowing earlier initiation of treatment options.
Case presentation: We herein report a case of cutaneous lymphangiosarcoma in a 47-year-old breast carcinoma patient, which occurred 9 years after initial surgery and radiation therapy. Distant metastases were detected on 18F-FDG PET/CT. The patient underwent fore-quarter amputation of the upper limb and concurrent chemo-radiation therapy. However, she succumbed to her disease after 3 cycles of chemotherapy.
Conclusions: 18F-FDG PET/CT scan helps in the early detection of malignant transformation and lymphangiosarcoma in a setting of chronic lymphedema in breast carcinoma patients following radiation therapy to the axilla. Furthermore, it helps determine the extent of regional spread and detect metastatic involvement, thus enabling better clinical management of these patients.

Keywords

Main Subjects


  1. Gottlieb R, Serang R, Chi D, Menco H. Stewart-Treves syndrome. Radiol Case Rep. 2015; 7(4):693.
  2. Taşdemir A, Karaman H, Ünal D, Mutlu H. Stewart-Treves Syndrome after bilateral mastectomy and radiotherapy for breast carcinoma: Case report. The Journal of Breast Health. 2015; 11(2):92.
  3. Vojtíˇsek R, Kinkor Z, Fínek J. Secondary angiosarcomas after conservation treatment for breast cancers. Klin Onkol. 2011; 24(5):382-88.
  4. Sharma A, Schwartz RA. Stewart-Treves syndrome: Pathogenesis and management. J Am Acad Dermatol. 2012; 67(6):1342-48.
  5. Stacey GS, Mahal RS, Peabody TD. Staging of Bone tumours: A review with illustrative examples. AJR Am J Roentgenol. 2006; 186:967-76.
  6. Jensen MR, Friberg L, Karlsmark T, et al. (18)F-FDG PET/CT in a rare case of Stewart-Treves syndrome: Future implications and diagnostic considerations. Lymphat Res Biol. 2011; 9:61-64.
  7. Young RJ, Brown NJ, Reed MW, et al. Lancet Oncol. 2010; 11: 983-91.
  8. Florou V, Wilky BA. Current and future directions for angiosarcoma therapy. Curr Treat Options Oncol. 2018; 19:14.
  9. Nascimento AF, Raut CP, Fletcher CD. Primary angiosarcoma of the breast: Clin-icopathologic analysis of 49 cases, suggesting that grade is not prognostic. AmJ Surg Pathol. 2008; 32(12):1896–1904.
  10. Stanczyk M, Gewartowska M, Swierkowski M, Grala B, Maruszynski M. Stewart-Treves syndrome angiosarcoma expresses phenotypes of both blood and lymphatic capillaries. Chinese Medical Journal. 2013; 126(2):231-7.
  11. Ruocco V, Schwartz RA, Ruocco E. Lymphedema: an immunologically vulnerable site for development of neoplasms. J Am Acad Dermatol.2002; 47(1):124-27.
  12. Aygit AC, Yildirim AM, Dervisoglu S. Lymphangiosarcoma in chronic lympho-edema. Stewart-Treves syndrome. J Hand Surg Br. 1999; 24(1):135-37.
  13. Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ. Angiosarcoma. The lancet oncology. 2010; 11(10):983-91.
  14. Grobmyer SR, Daly JM, Glotzbach RE, Grobmyer III AJ. Role of surgery in the management of postmastectomy extremity angiosarcoma (Stewart‐Treves syndrome). Journal of surgical oncology. 2000; 73(3):182-8.
  15. Tateishi U, Yamaguchi U, Seki K, Terauchi T, Arai Y, Kim EE. Bone and soft-tissue sarcoma: preoperative staging with fluorine 18 fluorodeoxyglucose PET/CT and conventional imaging. Radiology. 2007; 245(3):839-47.
  16. Lin H, Ozkan E, Erkan M, Viejo-Rullan F, Mikhaeil M, Mosavi A, Piperkova E, et al. Incremental value of FDG/PET in initial staging of patients with bone and soft tissue sarcoma. J Nucl Med 2008; 49: 149P.
  17. Almond MH, Jones RL, Thway K, Fisher C, Moskovic E, Judson IR. Atypical metastatic profile in Stewart-Treves syndrome. Acta Oncologica. 2010; 49(8):1388-90.
  18. McHaffie DR, Kozak KR, Warner TF, Cho CS, Heiner JP, Attia S. Stewart-Treves syndrome of the lower extremity. Journal of Clinical Oncology. 2010; 28(21):e351-2.
  19. Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics. 2005; 25(5):1357-68.
  20. Mamelak AJ, Collie MR, Kroll R, Hanson ML, Harris HM. Lymphangiosarcoma of the Scalp. Journal of Cutaneous Medicine and Surgery. 2014; 18(2):132-6.
  21. Di Meo N, Drabeni M, Gatti A, Trevisan G. A Stewart-Treves syndrome of the lower limb. Dermatol Online J.; 18(6):14.
  22. McKeown DG, Boland PJ. Stewart–Treves syndrome: A case report. Ann R CollSurg Engl. 2013; 95(5):e80-e82.
  23. McHaffie DR, Kozak KR, Warner TF, Cho CS, Heiner JP, Attia S. Stewart-Treves syndrome of the lower extremity. Journal of Clinical Oncology. 2010 28(21):e351-2.
  24. Cozen W, Bernstein L, Wang F, Press MF, Mack TM. The risk of angiosarcoma following primary breast cancer. British journal of cancer. 1999; 81(3):532-6.
  25. Joshi P, Lele V, Gandhi R. Fluorodeoxy-glucose positron emission tomography-computed tomography scan and nuclear magnetic resonance findings in a case of Stewart-Treves syndrome. J Cancer Res Ther. 2011; 7(3):360-3.
  26. Chen YR, Hsieh TC, Yen KY, Kao CH. Distant metastases in a young woman with Stewart-Treves syndrome demonstrated by an FDG-PET/CT scan. Clinical Nuclear Medicine. 2014; 39(11):975-6.
  27. Dawlatly SL, Dramis A, Sumathi VP, Grimer RJ. Stewart–Treves syndrome and the use of positron emission tomographic scanning. Annals of Vascular Surgery. 2011; 25(5): 699-e1.