Significance of 18 F-FDG PET and immunohistochemical GLUT-1 expression for cardiac myxoma
© Okazaki et al.; licensee BioMed Central Ltd. 2014
Received: 28 March 2014
Accepted: 21 May 2014
Published: 16 June 2014
Cardiac tumours are relatively rare and are difficult to diagnose merely with imaging techniques. We demonstrated an unusual case of left atrial myxoma, displaying the successful detection by positron emission tomography using 2-deoxy-2-[18 F] fluoro-D-glucose (18 F-FDG PET), correlated closely to more intense and enhanced immunoreactivity with glucose transporter-1 (GLUT-1) in a substantial number of cardiac myxoma cells. Further prospective studies are needed to validate the significance of 18 F-FDG PET findings for cardiac myxoma and the association with immunohistochemical GLUT-1 expression in its tumour cells, after collecting and investigating a larger number of surgical cases examined with both of them.
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Letter to the editor
The imaging technique of positron emission tomography with 2-deoxy-2-[18 F] fluoro-D-glucose (18 F-FDG PET) is based on the early observations by Warburg, that neoplastic (especially, malignant) cells accumulate more glucose than non-neoplastic cells do, as a result of high rate of glycolytic catabolism rather than citric acid cycle catabolism . 18 F-FDG PET has thus been increasingly performed in the diagnosis, pre-operative cancer staging, or follow-up post-treatment examination of many types of malignancy, whereas few studies have been reported regarding the utility of 18 F-FDG PET in intracardiac tumours [2–4]. Herein we reported an unusual case of left atrial myxoma, showing the successful detection by its technique, correlated closely to greater immunoreactivity with glucose transporter-1 (GLUT-1) in a larger number of cardiac myxoma cells.
Indeed, myxomas, as many as 60% of relatively rare cardiac tumours, could be considered to be common diseases, compared with some recently published papers of very unusual tumour cell types or features in the heart [2, 6]. Despite that, merely three case reports of atrial myxoma have demonstrated its appearance and utility in 18 F-FDG PET, revealing a moderately elevated glucose metabolism, very similar to our case, and likely assuming an established position in the routine clinical evaluation of cardiac tumours [2–4]. Furthermore, we describe the present unusual case, since it is conceivable that the current short report of cardiac myxoma located on the left atrium is clinicopathologically remarkable for another reason at least. A higher 18 F-FDG uptake rate in the present case could have a close correlation with a more specific and greater immunohistochemical expression of GLUT-1 in the myxoma cells, corresponding to the malignant cells in intraductal papillary mucinous neoplasms of the pancreas, as previously reported . Enhanced expression of GLUT-1 has actually been recognized in various cancer tissues examined, since one of the pivotal functions of ubiquitous GLUT-1 is known to particularly increase the glucose supply to dividing and growing cells in part, among a family of GLUT transporters [8, 9], possibly unlike these benign myxoma cells with relatively low MIB-1 index. However, the potential biological roles of accelerated glucose utilization in neoplastic cells still remain to be elucidated in detail. Nevertheless, it would be intriguing to assess the significance of 18 F-FDG PET findings for cardiac myxoma and the association with immunohistochemical GLUT-1 expression in the myxoma cells on future larger studies. The present short case report could interest the scientific community, taken together with potentially new and specific clinicopathological findings.
Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
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