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@#Primitive neuroectodermal tumours (PNETs) occurring directly from the lung parenchyma without involvement of the chest wall or pleura are particularly unusual. We describe a 16-year-old male who presented with severe chest and back pain following a fall during high jump competition. Incidental finding of an opacity at the right lung upper lobe was seen on his chest radiograph. Computed tomography of the thorax demonstrated a lobulated hypodense lesion in the anterior segment of right upper lobe and subsequent biopsy confirmed the diagnosis of Ewing Sarcoma/ PNET following histologic and immunohistochemical examination. Whole-body positron emission computed tomography/computed tomography (PET/CT) revealed mild, homogenous F18-fluorodeoxyglucose (FDG) uptake in the lung lesion with no evidence of metastasis. He eventually underwent right thoracotomy and right upper lobectomy. Indeed, F18-FDG PET/CT is a valuable imaging method in demonstrating active focus of glucose metabolism in lung parenchymal lesion, for preoperative evaluation and as baseline scan for patient’s monitoring.
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The detection rate of thyroid incidentalomas is increasing; in fact, as many as 2.3% of patients undergoing FDG PET-CT for other indications have been found to have thyroid incidentalomas. The risk of malignancy in these thyroid incidentalomas can be as high as 47%. The increased uptake and the focal uptake pattern of F-18 fluorodeoxyglucose (FDG) in the thyroid during positron emission tomography (PET)-computed tomography (CT), and the calcification of the thyroid incidentaloma, are associated with even higher risk of malignancy. We report a case of a lady undergoing FDG PET-CT for breast cancer staging but noted to have a calcified thyroid incidentaloma, which was proven to be follicular thyroid carcinoma.
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Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed. Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma. Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy. Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis. Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.
