Case 34
History:
65 y.o. male with Adenocarcinoma of gastroesophageal junction, 42 Days Post-Op from laparotomy, abdominal washout and duodenal repair. Adenocarcinoma of the EG junction found on investigations for dysphagia and weight loss. The patient has two PET-CT study; after staging laparoscopy (A and B), and after induction chemotherapy (C).
Status post staging laparoscopy and insertion of a Feeding jejunostomy (8 weeks ago). Describe the findings of pre-treatment PET-CT:
(A)
(B)
Findings: There is increased uptake in the distal esophagus with (maximum SUV 6.1), consistent with esophageal cancer. There are no suspicious paraoesophageal lymph nodes. Diffusely increased uptake in the gastric wall, could be physiological.
Now describe the findings in post induction chemotherapy PET-CT:
(C)
Findings: The abnormal esophageal uptake seen previously has significantly reduced (SUV max 3.0 vs 6.1). FDG uptake suggests an adequate response to treatment. Redemonstration of diffuse mild FDG uptake in the gastric wall with interval decreased FDG uptake.
Question1. What are the differential diagnosis of diffuse gastric FDG uptake? •Linitis plastica •Primary gastric adenocarcinoma •lymphoma •Breast cancer metastasis •Chronic gastritis