Figure 1.

A 55-year-old female with bilateral retropharyngeal amyloidomas. PET/CT coronal image (a) demonstrates heterogeneous FDG uptake, with greatest FDG uptake within the amyloidomas’ upper nasopharyngeal component (thick arrows) and geographic regions of low FDG uptake within the lower lesions (thin arrows) at the oropharynx level. Contrast-enhanced neck CT axial image (b) at the upper oropharynx level reveals well-defined bilateral retropharyngeal masses, containing tiny calcifications on the left (small black arrow). On CT these masses demonstrate variable contrast enhancement that is more homogeneous and intense on the right (thick white arrow) than the left (thin white arrow). MRI coronal T2 (c), T1 (d) and post-contrast T1 (e)-weighted images demonstrate amyloidoma heterogeneity, with their upper FDG avid component appearing T2 and mildly T1 hyperintense relative to muscle with marked post-contrast enhancement (thick arrows). The inferior amyloidoma components (thin arrows), with predominant low FDG uptake, are mildly T2 and T1 hypointense to muscle, with heterogeneous, less intense contrast enhancement. Pathology slide (H/E stain, 10× magnification) (f) from oropharynx level biopsy of the right pharyngeal lesion demonstrates a heavy background of eosinophilia (black arrow) with scant plasma cells, and a focal collection of plasma cells within its superior aspect (thick white arrow).

PET/CT: positron emission tomography/computed tomography; FDG: F-18 fluorodeoxyglucose; MRI: magnetic resonance imaging; H/E: hematoxylin and eosin.