Case 52
Presentation:
51-years -male with left upper lobe lesion and mediastinal adenopathy; FDG PET-CT was performed for initial staging;
Describe the findings in the following three series of images:
Fig-1 : Anterior and posterior projections of MIP
A B
Fig-1: MIP anterior view shows intense FDG uptake in the anterior mouth and small submandibular lymph node and the lateral view shows uptake in the central/Para hilar of the left lung with foci of uptake in mediastinum likely lymph nodes involvement. There is a low-grade uptake in the anterior part of the LUL.
Fig-2: Transaxial fused PET/CT images and corresponding CT images of the head at the level of the mandible.
Fig-2: There is intense uptake within the anterior and inferior aspect of the tongue approximately measuring 2.5 x 2.4 cm which demonstrates a central air density likely representing a necrotizing lesion with SUV max 17.8
Fig-3: Transaxial fused PET/CT images and corresponding CT images of the chest at the level of AP window.
Fig-3: There is an intensely FDG avid para hilar lesion causing atelectasis of the anterior segment of the left upper lobe (measures 3.4 x 2.3 cm, SUV max 13.9). There is also increased uptake in the atelectatic part of the left upper lobe. There are FDG avid mediastinal lymphadenopathy.
18F-FDG PET-CT scan conclusion along with pathology result:
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A necrotizing FDG avid lesion in the inferior surface of the tip of the tongue with FDG avid submental and cervical lymphadenopathy, biopsy-proven to be a moderately differentiated squamous cell carcinoma.
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A left para hilar FDG avid mass in the lung with atelectasis of the left upper lobe and multiple left mediastinal FDG avid lymphadenopathy, biopsy proven to be another squamous cell carcinoma.
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No definite evidence of metastatic deposits to the right side of the mediastinum or supraclavicular regions (excluding submental and cervical lymph nodes from primary tongue cancer).
The staging of the lung cancer based on AJCC eighth edition would be as follow:
T2b N2 M0
Questions:
What is your opinion on FDG-avid lesions in the tongue and lung?
Which one is likely the primary?
What is the incidence of head and neck squamous cell carcinoma occurring synchronously with a second primary in the lung?