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PET/CT Imaging in Oncology: Exceptions That Prove the Rule

PET/CT Imaging in Oncology: Exceptions That Prove the Rule Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 865032, 4 pages http://dx.doi.org/10.1155/2013/865032 Case Report 1 1 2 1 M. Casali, A. Froio, C. Carbonelli, and A. Versari Nuclear Medicine Unit, Department of Advanced Technology, Azienda Ospedaliera Santa Maria Nuova, IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy Pulmonology Unit, Department of Cardiology, or Th acic and Vascular Surgery and Critical Care Medicine, Azienda Ospedaliera Santa Maria Nuova, IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy Correspondence should be addressed to M. Casali; massimiliano.casali@asmn.re.it Received 22 November 2012; Accepted 31 December 2012 Academic Editors: J. Itami, M. Ryberg, and G. P. Vandoros Copyright © 2013 M. Casali et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. F-FDG PET/CT is a diagnostic three-dimensional non-invasive device, routinely employed in neurology, cardiology, and oncology, and which contributes to patient care giving functional informations about glucose metabolism. In particular, staging, restaging, follow-up and response to treatment of tumors are the most common applications in oncologic field. Many neoplasms show increased glucose metabolism and consequent F-FDG uptake. Nevertheless, some relative differentiated cancers, such as clear cell carcinoma of the kidney and bronchioloalveolar adenocarcinoma, show tipically faintly/no uptake resulting in a consequent negative PET/CT scan. This case report represents an extreme case in which three relative well-differentiated cancer forms,allcharacterizedbylowglucosemetabolism,aeff ctthesamepatientatthesametimewhile F-FDG PET/CT scan is negative. 1. Introduction lymphadenopathies (Figures 1 and 2). An increase in size of left adrenal gland was also described. In January 2012 a biopsy F-FDG is an established agent for detecting and staging of vocal cords was done with diagnosis of mildly differen- tumors [1, 2]. However the most common limits of this tiated infiltrating squamous cell carcinoma only for the left technique are represented by well-differentiated cancer forms cord. en Th an abdominal CT scan was done with accidental and in general tumors with low proliferative index [2]. The finding of a neoplastic mass of 6 cm of maximum diameter in uniqueness of this case report consists in the concurrence of the left kidney ( Figure 3). At the end of January 2012, vfi e days three metachronous cancers all characterized by low glucose aer ft left vocal cord biopsy, the patient underwent a F-FDG metabolism and a consequent negative PET/CT study. PET/CT scan (blood glucose level at the administration of the tracer was 87 mg/dL) with diagnosis of faint tracer uptake of the already known right pulmonary nodule (SUVmax 1.3) 2. Case Report and also diagnosis of only one right paratracheal suspicious Patient: male, 65 yrs old. In December 2011th underwent an lymphadenopathy (SUVmax 4.6) worthy of followup (Figures ENTvisit becauseofrecentonset of dysphoniainsmoking 4, 5,and 6). At the beginning of February 2012 the patient was status (20 cigarettes/die) with objective diagnosis of clear subjected to CO -laser endoscopic laryngectomy. Histology nasal passages, normal oropharynx, normal larynx motility, confirmed the presence of mildly differentiated infiltrating and leukoplakia infiltrating the anterior third of the left vocal squamous cell carcinoma. In February he was subjected to an atypical resection of the right upper lung nodule and to lym- cord. eTh day aer ft the ENT visit he also underwent a chest X- raywithaccidentaldiagnosis of rightpulmonary upperlobe phadenectomy of the node identified at the PET/CT study. nodule worthy of thorough investigation with a computed Bioptic examination revealed a well-differentiated lung ade- tomography. CT scan of the chest confirmed nodule presence, nocarcinoma characterized by 90% of lipid component and indicating the neoplastic nature, and also lower paratracheal a remaining part of infiltrating acinous pattern, unexpectedly (right), mediastinal para-aortic, and right pulmonary hilar a mediastinal node involvement by clear cell carcinoma 2 Case Reports in Oncological Medicine Figure 1: Accidental nodule of the right pulmonary upper lobe (arrow). Figure 2: Mediastinal lymphoadenopathies (arrow). Figure 3: Accidental radiological finding of left renal mass (arrow). suspicious of renal origin. Finally, in April 2012, the patient diagnostic devices [3–5]. However the most common limits underwent left nephrectomy with associated homolateral of this technique are represented by well-differentiated cancer adrenal removal. Histology conrfi med the presence of clear forms and in general tumors with low proliferative index cell renal carcinoma and adenomatous hyperplasia of the left [6, 7]. Bronchioloalveolar lung adenocarcinoma or clear cell adrenal gland. tumor of the kidney is the most common example of low neoplastic uptake of F-FDG [8]. The uniqueness of this case report consists in the concurrence of three metachronous 3. Discussion cancers (mildly differentiated infiltrating squamous cell car- cinoma, well-differentiated lung cancer, and clear cell renal In recent years F-FDG PET/CT has worldwide demon- strated itself as one of the most important oncological carcinoma) all characterized by low glucose metabolism Case Reports in Oncological Medicine 3 Figure 4: Faintly F-FDG uptake of the right pulmonary upper lobe—SUVmax 1.3 (arrow). Figure 5: Asymmetrical F-FDG uptake appreciable in larynx at PET/CT scan (arrow). and a consequent negative PET/CT study. A retrospective Only mildly asymmetrical uptake was appreciable in larynx (partial hypocaptation of the left vocal cord), but a few days evaluation of the F-FDG PET/CT scan was able to charac- before the patient had been subjected to vocal cord biopsy. terize only a very low uptake of the tracer by lung nodule, This is an extreme case, the exceptions that prove the rule, while no pathological uptake was seen in the left kidney. 4 Case Reports in Oncological Medicine Figure 6: Right paratracheal suspicious lymphadenopathy at PET/CT scan—SUVmax 4.6 (arrow). that reminds us that F-FDG is surely an optimal tracer but FDGuptakeonintegratedPET/CT2005,” European Radiology, nota“universal”tracervalid forall kindsofcancers andthat vol. 15, no. 10, pp. 2075–2078. allscenarios howeverunlikelyare possible,keeping in mind [8] K. Nakatani, Y. Nakamoto, T. Saga, T. Higashi, and K. Togashi, “eTh potential clinical value of FDG-PET for recurrent renal cell that a true cancer diagnosis is only bioptic. carcinoma,” European Journal of Radiology,vol.79, no.1,pp. 29– 35, 2011. References [1] A. Gordin, M. Daitzchman, I. Doweck et al., “Fluoro- deoxyglucose-positron emission tomography/computed tomography imaging in patients with carcinoma of the larynx: diagnostic accuracy and impact on clinical management,” Laryngoscope,vol.116,no. 2, pp.273–278,2006. [2] A. Almuhaideb, N. Papathanasiou, and J. Bomanji, “18F-FDG PET/CT imaging in oncology,” Annals of Saudi Medicine,vol. 31, no. 1, pp. 3–13, 2011. [3] M.Basely, S. Bonnel,P.Maszelin, P. Verdalle,E.Bussy,and J. P. De Jaureguiberry, “A rare presentation of metastatic renal clear cell carcinoma to the tongue seen on FDG PET,” Clinical Nuclear Medicine,vol.34, no.9,pp. 566–569, 2009. [4] K. Bouchelouche and P. Oehr, “Recent developments in urologic oncology: positron emission tomography molecular imaging,” Current Opinion in Oncology,vol.20, no.3,pp. 321–326, 2008. [5] M.M.A.Y.Chu,A.Kositwattanarerk, D. J. Leeetal.,“Fdgpet with contrast-enhanced CT: a critical imaging tool for laryngeal carcinoma,” Radiographics,vol.30, no.5,pp. 1353–1372, 2010. [6] S. Balogova, V. Huchet, K. Kerrou et al., “. Detection of bronchioloalveolar cancer by means of PET/CT and 18F- fluorocholine, and comparison with 18F-fluorodeoxyglucose,” Nuclear Medicine Communications,vol.31, no.5,pp. 389–397, [7] Y. M. Sung, K. S. Lee, B. T. Kim et al., “Lobar mucinous bronchioloalveolar carcinoma of the lung showing negative MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

PET/CT Imaging in Oncology: Exceptions That Prove the Rule

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Hindawi Publishing Corporation
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Copyright © 2013 M. Casali et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Publishing Corporation Case Reports in Oncological Medicine Volume 2013, Article ID 865032, 4 pages http://dx.doi.org/10.1155/2013/865032 Case Report 1 1 2 1 M. Casali, A. Froio, C. Carbonelli, and A. Versari Nuclear Medicine Unit, Department of Advanced Technology, Azienda Ospedaliera Santa Maria Nuova, IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy Pulmonology Unit, Department of Cardiology, or Th acic and Vascular Surgery and Critical Care Medicine, Azienda Ospedaliera Santa Maria Nuova, IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy Correspondence should be addressed to M. Casali; massimiliano.casali@asmn.re.it Received 22 November 2012; Accepted 31 December 2012 Academic Editors: J. Itami, M. Ryberg, and G. P. Vandoros Copyright © 2013 M. Casali et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. F-FDG PET/CT is a diagnostic three-dimensional non-invasive device, routinely employed in neurology, cardiology, and oncology, and which contributes to patient care giving functional informations about glucose metabolism. In particular, staging, restaging, follow-up and response to treatment of tumors are the most common applications in oncologic field. Many neoplasms show increased glucose metabolism and consequent F-FDG uptake. Nevertheless, some relative differentiated cancers, such as clear cell carcinoma of the kidney and bronchioloalveolar adenocarcinoma, show tipically faintly/no uptake resulting in a consequent negative PET/CT scan. This case report represents an extreme case in which three relative well-differentiated cancer forms,allcharacterizedbylowglucosemetabolism,aeff ctthesamepatientatthesametimewhile F-FDG PET/CT scan is negative. 1. Introduction lymphadenopathies (Figures 1 and 2). An increase in size of left adrenal gland was also described. In January 2012 a biopsy F-FDG is an established agent for detecting and staging of vocal cords was done with diagnosis of mildly differen- tumors [1, 2]. However the most common limits of this tiated infiltrating squamous cell carcinoma only for the left technique are represented by well-differentiated cancer forms cord. en Th an abdominal CT scan was done with accidental and in general tumors with low proliferative index [2]. The finding of a neoplastic mass of 6 cm of maximum diameter in uniqueness of this case report consists in the concurrence of the left kidney ( Figure 3). At the end of January 2012, vfi e days three metachronous cancers all characterized by low glucose aer ft left vocal cord biopsy, the patient underwent a F-FDG metabolism and a consequent negative PET/CT study. PET/CT scan (blood glucose level at the administration of the tracer was 87 mg/dL) with diagnosis of faint tracer uptake of the already known right pulmonary nodule (SUVmax 1.3) 2. Case Report and also diagnosis of only one right paratracheal suspicious Patient: male, 65 yrs old. In December 2011th underwent an lymphadenopathy (SUVmax 4.6) worthy of followup (Figures ENTvisit becauseofrecentonset of dysphoniainsmoking 4, 5,and 6). At the beginning of February 2012 the patient was status (20 cigarettes/die) with objective diagnosis of clear subjected to CO -laser endoscopic laryngectomy. Histology nasal passages, normal oropharynx, normal larynx motility, confirmed the presence of mildly differentiated infiltrating and leukoplakia infiltrating the anterior third of the left vocal squamous cell carcinoma. In February he was subjected to an atypical resection of the right upper lung nodule and to lym- cord. eTh day aer ft the ENT visit he also underwent a chest X- raywithaccidentaldiagnosis of rightpulmonary upperlobe phadenectomy of the node identified at the PET/CT study. nodule worthy of thorough investigation with a computed Bioptic examination revealed a well-differentiated lung ade- tomography. CT scan of the chest confirmed nodule presence, nocarcinoma characterized by 90% of lipid component and indicating the neoplastic nature, and also lower paratracheal a remaining part of infiltrating acinous pattern, unexpectedly (right), mediastinal para-aortic, and right pulmonary hilar a mediastinal node involvement by clear cell carcinoma 2 Case Reports in Oncological Medicine Figure 1: Accidental nodule of the right pulmonary upper lobe (arrow). Figure 2: Mediastinal lymphoadenopathies (arrow). Figure 3: Accidental radiological finding of left renal mass (arrow). suspicious of renal origin. Finally, in April 2012, the patient diagnostic devices [3–5]. However the most common limits underwent left nephrectomy with associated homolateral of this technique are represented by well-differentiated cancer adrenal removal. Histology conrfi med the presence of clear forms and in general tumors with low proliferative index cell renal carcinoma and adenomatous hyperplasia of the left [6, 7]. Bronchioloalveolar lung adenocarcinoma or clear cell adrenal gland. tumor of the kidney is the most common example of low neoplastic uptake of F-FDG [8]. The uniqueness of this case report consists in the concurrence of three metachronous 3. Discussion cancers (mildly differentiated infiltrating squamous cell car- cinoma, well-differentiated lung cancer, and clear cell renal In recent years F-FDG PET/CT has worldwide demon- strated itself as one of the most important oncological carcinoma) all characterized by low glucose metabolism Case Reports in Oncological Medicine 3 Figure 4: Faintly F-FDG uptake of the right pulmonary upper lobe—SUVmax 1.3 (arrow). Figure 5: Asymmetrical F-FDG uptake appreciable in larynx at PET/CT scan (arrow). and a consequent negative PET/CT study. A retrospective Only mildly asymmetrical uptake was appreciable in larynx (partial hypocaptation of the left vocal cord), but a few days evaluation of the F-FDG PET/CT scan was able to charac- before the patient had been subjected to vocal cord biopsy. terize only a very low uptake of the tracer by lung nodule, This is an extreme case, the exceptions that prove the rule, while no pathological uptake was seen in the left kidney. 4 Case Reports in Oncological Medicine Figure 6: Right paratracheal suspicious lymphadenopathy at PET/CT scan—SUVmax 4.6 (arrow). that reminds us that F-FDG is surely an optimal tracer but FDGuptakeonintegratedPET/CT2005,” European Radiology, nota“universal”tracervalid forall kindsofcancers andthat vol. 15, no. 10, pp. 2075–2078. allscenarios howeverunlikelyare possible,keeping in mind [8] K. Nakatani, Y. Nakamoto, T. Saga, T. Higashi, and K. Togashi, “eTh potential clinical value of FDG-PET for recurrent renal cell that a true cancer diagnosis is only bioptic. carcinoma,” European Journal of Radiology,vol.79, no.1,pp. 29– 35, 2011. References [1] A. Gordin, M. Daitzchman, I. Doweck et al., “Fluoro- deoxyglucose-positron emission tomography/computed tomography imaging in patients with carcinoma of the larynx: diagnostic accuracy and impact on clinical management,” Laryngoscope,vol.116,no. 2, pp.273–278,2006. [2] A. Almuhaideb, N. Papathanasiou, and J. Bomanji, “18F-FDG PET/CT imaging in oncology,” Annals of Saudi Medicine,vol. 31, no. 1, pp. 3–13, 2011. [3] M.Basely, S. Bonnel,P.Maszelin, P. Verdalle,E.Bussy,and J. P. De Jaureguiberry, “A rare presentation of metastatic renal clear cell carcinoma to the tongue seen on FDG PET,” Clinical Nuclear Medicine,vol.34, no.9,pp. 566–569, 2009. [4] K. Bouchelouche and P. Oehr, “Recent developments in urologic oncology: positron emission tomography molecular imaging,” Current Opinion in Oncology,vol.20, no.3,pp. 321–326, 2008. [5] M.M.A.Y.Chu,A.Kositwattanarerk, D. J. Leeetal.,“Fdgpet with contrast-enhanced CT: a critical imaging tool for laryngeal carcinoma,” Radiographics,vol.30, no.5,pp. 1353–1372, 2010. [6] S. Balogova, V. Huchet, K. Kerrou et al., “. Detection of bronchioloalveolar cancer by means of PET/CT and 18F- fluorocholine, and comparison with 18F-fluorodeoxyglucose,” Nuclear Medicine Communications,vol.31, no.5,pp. 389–397, [7] Y. M. Sung, K. S. Lee, B. T. Kim et al., “Lobar mucinous bronchioloalveolar carcinoma of the lung showing negative MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 International Journal of Journal of Immunology Research Endocrinology Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Submit your manuscripts at http://www.hindawi.com BioMed PPAR Research Research International Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Research and Treatment Cellular Longevity Neurology Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation Hindawi Publishing Corporation http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: Feb 27, 2013

References