Relationship between FDG-PET and GLUT-1 immunostaining of primary musculoskeletal tumors.

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Positron emission tomography (PET) can provide an in vivo method for evaluating metabolism and physiology in normal and diseased tissues. Clinical trials with [18F] 2-deoxy-2-fluoro-D-glucose (FDG), the most commonly used radiolabeled tracer for PET imaging, have demonstrated increased accumulation of FDG in several cancer tissues. Recent reports and our own experiences suggest that FDG-PET might not accurately reflect malignant potential of musculoskeletal tumors, but rather implicate cellular components included in the lesions. A high accumulation of FDG can be observed in histiocytic, fibroblastic, and some neurogenic lesions, regardless of whether they are benign or malignant.In this research project, we have tried to compare FDG uptake on PET study to glucose transporter-1 (GLUT-1) immunostaining of musculoskeletal tumors. For the first step, we have selected histiocytic tumors (malignant fibrous histiocytoma, giant cell tumor of bone and tendon sheath, non-ossifying fibroma, sarcoidosis, Langerhans cell histiocytosis, etc.) for the immunohistochemistry. So far, the immunostaining is not technically stable for formalin-fixed and paraffin-embedded sections. So, recently, we are trying the staining for sections of fresh specimens.The mechanism of FDG uptake in musculoskeletal tumors is continuously to be investigated, because we should know whether FDG-PET can be a screening method for differential diagnosis between benign and malignant musculoskeletal lesions, including many neoplasms originating from different tissues altogether.