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Overexpression of Glut1 in Lymphoid Follicles Correlates with False-Positive 18F-FDG PET Results in Lung Cancer Staging

Jin-Haeng Chung, MD1, Kyung-Ja Cho, MD2, Seung-Sook Lee, MD1, Hee Jong Baek, MD3, Jong-Ho Park, MD3, Gi Jeong Cheon, MD4, Chang-Woon Choi, MD4 and Sang Moo Lim, MD4

1 Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea
2 Department of Pathology, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea
3 Department of Thoracic Surgery, Korea Cancer Center Hospital, Seoul, Korea
4 Department of Nuclear Medicine, Korea Cancer Center Hospital, Seoul, Korea



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  		FIGURE 1. 18F-FDG PET of mediastinal lymph nodes. (A) 18F-FDG PET image of TP lymph node in 64-y-old man. 18F-FDG PET scan shows hypermetabolic lung mass in right middle lobe with standardized uptake value (SUV) of 8.4 and small hypermetabolic lymph node in prevascular space with SUV of 6.3. Lymph node had high activity of 18F-FDG with focal appearance on 18F-FDG PET, so lesion was classified preoperatively as a metastatic lymph node. After surgery, adenocarcinoma and lymph node metastasis were proven on pathologic examination of surgical specimen. (B) 18F-FDG PET image of FP lymph node in 64-y-old man. 18F-FDG PET scan shows hypermetabolic lung mass in right upper lobe with SUV of 12.5 and small hypermetabolic lesion in right paratracheal lymph node with SUV of 4.3. Lymph node had high activity of 18F-FDG with focal appearance on 18F-FDG PET, so lesion was classified preoperatively as a metastatic lymph node. After surgery, squamous cell carcinoma was proven in the main mass, but there was no metastasis in lymph node.

 


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  		FIGURE 2. Glut1 immunostaining in metastatic non-small cell carcinomas. (A) Squamous cell carcinoma with strong membranous Glut1 immunostaining (STAIN, x200). (B) Adenocarcinoma with focal cytoplasmic Glut1 immunostaining (immunostain, x200).

 


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  		FIGURE 3. Glut1 immunostaining in lymphoid follicles. Note intense linear membranous staining in lymphoid follicular cells and erythrocytes as an internal positive control (immunostain, x200).

 




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