Key result
Marginal excision of a highly FDG-avid hibernoma mimicking liposarcoma achieves complete resection without 12-month recurrence.
Why the study?
Hibernomas can demonstrate high FDG avidity on PET/CT, mimicking malignant sarcomas and leading to unnecessary aggressive management.
Case Report (n=1)
Hibernoma should be considered in the differential diagnosis of highly FDG-avid lipomatous soft tissue masses, even with SUVmax >30, to avoid unnecessary aggressive treatment.
High FDG avidity in lipomatous masses may represent benign hibernoma; this case leaves open whether biopsy remains mandatory for exclusion of sarcoma.
Hibernomas are rare benign tumors of brown adipose tissue that can demonstrate remarkably high fluorodeoxyglucose (FDG) avidity on positron emission tomography/computed tomography (PET/CT), often mimicking malignant sarcomas and leading to unnecessary aggressive management. A 65-year-old woman with peripheral arterial disease underwent CT angiography that incidentally revealed a large (9 × 8.5 cm) mixed-density lipomatous mass in the proximal left thigh. MRI confirmed a well-encapsulated lesion with signal intensity consistent with fat on T1-weighted imaging, strikingly prominent internal vascular channels, and a feeding vascular pedicle. PET/CT demonstrated intense hypermetabolism with a maximum standardized uptake value (SUVmax) of 34.8-among the highest reported for hibernoma-and a central photopenic area corresponding to vascular spaces. Core biopsy suggested hibernoma (positive for S100 and CD10, negative for MDM2), creating significant radiological-pathological discordance given the aggressive imaging appearance. Multidisciplinary tumor board review recommended marginal excision, which confirmed a completely resected hibernoma; the patient remained recurrence-free at 12-month follow-up. Hibernoma should be considered in the differential diagnosis of any FDG-avid lipomatous soft tissue mass, particularly when imaging shows prominent internal vascularity and absence of thickened fibrous septa. An SUVmax exceeding 30 does not exclude benignity, and recognizing these characteristic findings can improve diagnostic accuracy and help avoid unnecessary aggressive treatment.
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Papadia et al. (2026) conducted a case report in Hibernoma (n=1). Marginal excision was evaluated on Recurrence. Marginal excision of a highly FDG-avid hibernoma (SUVmax 34.8) mimicking liposarcoma resulted in complete resection, with the patient remaining recurrence-free at 12 months.
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