Unusual Metastatic Sites in Malignant Phyllodes Tumor Detected on FDG PET/CT.

Phyllodes tumor is a rare fibroepithelial neoplasm of the breast. This tumor tends to spread by hematogenous route, with common metastatic sites in the lungs, bones, and liver. Metastases to the pleura, stomach, pancreas, kidneys, and adrenal gland are rare. We present a case of a 52-year-old lady with malignant phyllodes tumor of breast undergone local tumor resection, followed by solitary lung metastasis with lobectomy, and subsequently diagnosed of multiple new metastatic sites in pleura, stomach, pancreas, kidneys, adrenal gland, and bone detected on 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography within 2 years.

Retrospective study of qualitative assessment in detecting synchronous and metachronous malignancies in adult cancer patients by 18 F-FDG PET/CT.

OBJECTIVES: The study aimed to evaluate the frequency of incidental suspicious lesions detected by flourine-18 fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) scans done for staging or restaging in adult cancer patients. We further determined the detection rate of synchronous and metachronous malignancies in these suspicious lesions after further investigations. MATERIALS AND METHODS: This retrospective analysis evaluated the consecutive patients with 18 F-FDG PET/CT scans done in Queen Elizabeth Hospital (QEH), Hong Kong between July 2021 and June 2022. The adult cancer patients who underwent staging or restaging 8 F-FDG PET/CT were included while the remaining were excluded. Patients' demographics, primary cancer type, tumor markers, and pathological analyses for the incidental suspicious lesions were reviewed to establish the detection rate of synchronous and metachronous malignancies. RESULTS: A total of 2054 patients fulfilled inclusion criteria with age ranging from 18 to 93 years old. Out of the 2054 patients, 304 (14.8%) were found to have incidental suspicious lesions. Of these, 206 patients (67.8%) underwent further investigations including pathological analyses. Subsequently, 84 of these 206 patients (40.8%) had pathologically proven synchronous or metachronous malignancies. CONCLUSION: The detection rate of incidental suspicious lesions in adult cancer patients who underwent 18 F-FDG PET/CT scans for staging or restaging was 14.8% and the rate of synchronous and metachronous malignancies in these suspicious lesions was 40.8%. The treatment plan of these patients may potentially be altered, which should be included in the cost-benefit analysis of using this imaging modality.

Giant parathyroid adenoma and hungry bone syndrome in MEN1 syndrome: A case report.

An 18-year-old male with multiple endocrine neoplasm type 1 (MEN1) syndrome presented with hyperparathyroidism. Parathyroidectomy was performed. Patient complained of bone pain afterwards, multiple imaging modalities revealed features of osteitis fibrosa cystica and biochemical profile showed features of hungry bone syndrome. Incidental suspicious pancreatic lesion was initially revealed by 18F-FDG PET/CT scan while MRI further characterized the possibility of insulinoma. Ultimately, the patient was diagnosed of MEN1 syndrome by genetic test. This case report demonstrates the utilization of various imaging modalities such as ultrasound, Tc99m-sestamibi parathyroid scintigraphy, bone scintigraphy, CT, PET/CT and MRI, which leads to ultimately the diagnosis of MEN1 syndrome.

A case series of FDG PET scan: hypometabolic lesions that matter in oncology.

Interpretation of FDG PET images in oncology patients is in general a visual exercise of search for focal increased uptake (hypermetabolism). However, in some cases, hypometabolism (focal decreased uptake) can matter as much as hypermetabolism. We report three cases of FDG PET studies for oncological indications. All of them showed focal hypometabolic lesions suspicious of metastases. The diagnoses were then supported either by histological proof and/or follow-up imaging studies. The importance of being alert to both focal hypermetabolism and focal hypometabolism when interpreting FDG PET images is underscored.

A case of dermatopathic lymphadenitis mimicking lymphoma on 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging.

This case report illustrates a rare case of dermatopathic lymphadenitis with interval 18F-fluorodeoxyglucose positron emission tomography/ computed tomography performed. The clinical presentation, imaging, and histological findings are described. We discuss the diagnostic challenges in this case.

An update on the role of 18F-FDG-PET/CT in major infectious and inflammatory diseases.

For decades, conventional nuclear medicine techniques have been utilized for the assessment of many infectious and inflammatory diseases. Most of these techniques have limitations such as the relatively low spatial resolution, being time consuming and low sensitivity or specificity. In recent years, FDG-PET/CT has shown promising role in the management of such diseases. An expanding set of studies illustrate the multifarious roles of FDG-PET/CT in the assessment of these conditions, both systemic diseases and more regional. Specifically, PET can provide vital information at a molecular level and consequently detect the disease activity at their earliest manifestation. With the continuing research on the diagnosis and treatment monitoring of patients with infectious and inflammatory diseases, the role of PET/CT can be further extended.