Pigmented villous nodular synovitis mimicking metastatic melanoma on PET-CT.
BACKGROUND
Positron Emission Tomography - Computed Tomography (PET-CT) is routinely utilized in the management of melanoma, either as a part of staging workup or during surveillance. Since melanomas have a high metastatic potential, any FDG avid lesion is considered suspicious for recurrence. We report a case of a FDG avid lesion, diagnosed during melanoma surveillance, its management and review of literature.


METHODS
A 58 year-old-male underwent wide local excision for melanoma of the left cheek, and one year post-operatively a PET-CT that revealed a hypermetabolic focus in his right subscapularis muscle, which upon resection was diagnosed as Pigmented Villonodular Synovitis (PVNS).


CONCLUSIONS
PVNS is a rare benign giant cell tumor that requires no additional treatment in asymptomatic individuals. PET-CT is used for staging and surveillance of numerous malignancies, including melanoma. A hypermetabolic lesion on a PET-CT scan in the setting of malignancy is always suspicious for recurrence.


CONCLUSIONS
The surgeon is reminded of a uncommon benign FDG avid lesion. Typical location, nonspecific symptoms and characteristic imaging findings help cue in the diagnosis of PVNS and a tissue diagnosis will establish the diagnosis, thus avoiding unnecessarily aggressive surgical management.
Department of Surgery, Division of Surgical Oncology, Hofstra North Shore LIJ School of Medicine, USA. Electronic address: luke.selby@gmail.com.
Luke
L
Selby
Department of Surgical Oncology, Roswell Park Cancer Institute, USA.
Moshim
M
Kukar
Department of Surgery, Division of Surgical Oncology, Hofstra North Shore LIJ School of Medicine, USA.
John
J
Wang
Department of Surgery, Division of Surgical Oncology, Hofstra North Shore LIJ School of Medicine, USA.
Mansoor
M
Beg
Department of Surgery, Division of Surgical Oncology, Hofstra North Shore LIJ School of Medicine, USA.
James
J
Sullivan
Metastatic melanoma; Pigmented villous nodular synovitis