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Detection of Unexpected Additional Primary Malignancies with PET/CT

Takayoshi Ishimori, MD, PhD1, Pavni V. Patel, MD1 and Richard L. Wahl, MD1

1 Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland



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  		FIGURE 1. Coronal PET/CT images of 73-y-old woman with recently diagnosed cancer in right lung. (A) Images show large 18F-FDG-avid mass in right lung (arrow), consistent with patient’s known lung cancer. Biopsy revealed small cell lung cancer. (B) Anterior slices from same PET/CT study showed 18F-FDG-avid nodule in left breast (arrow), highly suggestive of malignancy. Pathology revealed infiltrating ductal carcinoma. Thus, this case was true-positive for an additional primary malignancy.

 


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  		FIGURE 2. Coronal PET/CT images of 73-y-old woman with non-small cell right-upper-lobe lung cancer recently diagnosed by biopsy. (A) Lung mass shows intensely increased metabolic activity, compatible with the known lung cancer (arrow). (B) Additional slices from same PET/CT study showed increased activity in a right thyroid nodule (arrow). Fine-needle aspiration biopsy showed benign adenomatoid nodule. This case was thus falsely positive for an additional primary. Mildly increased activity seen in right axilla (arrowhead) was likely due to minimal tracer infiltration after right antecubital injection of tracer.

 




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