Case 36
Presentation:
History: 64 y.o. male presenting with worsening dysphagia worse with solids versus liquids. He found to have right hilar mediastinal mass and extensive lymphadenopathy. FDG PET/CT was performed for lung cancer diagnosis and staging.
Findings:
There are multiple extensive mildly to intensly FDG avid lesion involving lung and mediastinum for example :
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conglomerate lymph node involving right superior paratracheal, right and left inferior paratracheal, precarinal, subcarinal, subaortic, and right hilar stations, with maximum SUV reaching up to 9.51.
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The matted lymph node is contiguous with intensely FDG avid RLL large irregular consolidation mass, (6.3 x 7.3 cm, SUV max 11.65).
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Additionally, mildly FDG avid LLL solid nodules were identified. For example; 11 mm nodule, SUV max is 1.85, and 8 mm nodule , SUV max 1.43.
In the abdomen there are multiple FDG avid lesions involving solid and hollow organs as well as the mesentery, some of which are mildy FDG avid and others are intensely avid. Examples as follows:
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pancreatic head hypodense lesion ( SUV max 8.27, 2.1 x 2.2 cm )
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Moderately FDG avid lesion in the anterior aspects of the right mid renal pole , ( 1.6 x 1.3 cm, SUV max 6.2).
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Moderately FDG avid, SUV max 7.1, mesenteric soft tissue mass in the left side of the mid abdomen,
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Mildly FDG avid, SUV max 3.9, mesenteric nodule and prevesical nodules, with maximum SUV of 4.4.
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Right pelvic lymph nodes, along the external iliac measuring approximately 0.7 cm, SUV max 4.3
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internal iliac chains measuring approximately 1.7 cm, SUV max 3.4.
Review of bone windows demonstrates
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FDG avid sclerotic lesions in the right greater trochanter, SUV max 5.8, and left ischium SUV max 3.2 along with mixed lytic/sclerotic lesion in the left iliac bone SUV max 6.1.
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There is mildly FDG avid, SUV max 3.7, subcutaneous soft tissue nodule anterior to the left scapular body, measuring approximately 0. 7 x 1.3 cm.
What is your conclusion for this cases according to all the above mentioned findings?
Interpretation of this PET/CT is quite challenging, as there numerous lesions with variety of FDG avidity. Overall, Findings in keeping with metastatic disease as detailed below:
Biopsy of pancreatic lesion was consistent with poorly differentiated neuroendocrine carcinoma. Therefore, the above mentioned lung mass, could be considered as a small cell lung cancer with an extensive stage, presenting as locoregional and distant metastases as stated above.
Subsequently EUBS of station 4L Lymph node demonstrated Small cell carcinoma.