Recurrencia de un carcinoma gástrico de células en anillo de sello demostrada por PET-FDG / Recurrent signet-ring cell gastric carcinoma evidenced by FDG-PET

RESUMEN

Objetivo: Presentar la detección de una recurrencia secundaria a un carcinoma gástrico difuso, con células en anillo de sello e indiferenciado mediante PET-FDG. Material y métodos: Se trataba de un paciente con estadio III diagnosticado en 1994 y tratado con gastrectomía subtotal. En febrero del 2003 se diagnostica recurrencia mediastínica y supraclavicular izquierda, administrándose quimioterapia y radioterapia alcanzando respuesta completa. Tras 6 meses libre de enfermedad, presenta una elevación de marcadores tumorales con pruebas complementarias (endoscopia digestiva alta, gammagrafía ósea y TC) negativas, efectuándose PET-FDG para descartar recurrencia. Resultados: La PET-FDG identificó lesiones probablemente malignas en región supraclavicular derecha y en mediastino, confirmándose dichos hallazgos por seguimiento clínico y la realización de una TC 4 meses más tarde. Conclusiones: Destacamos la detección de recurrencia precoz por PET-FDG en un carcinoma no intestinal gástrico, circunstancia que creemos de interés dada la mayor dificultad de la PET-FDG en la detección de carcinomas productores y/o secretores de moco

ABSTRACT

Objective: To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease. Materials and methods: The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease. Results: FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later. Conclusions: In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG