Lung Cancer - 86-year-old female

History
An 86-year-old female with history of sigmoid carcinoma in 1991, invasive well-differentiated mucin-producing adenocarcinoma of large bowel with extension of tumor into a portion of the muscular layer but no involvement of the serosa. 2 of 3 lymph nodes are positive for metastatic disease. Follow-up 1/1999 stable clinical picture. Follow-up 7/2000 stable clinical picture, CEA level remains low at < 0.5 chest x-ray continues t show persistent irregular infiltration in the right upper lobe, being a possible scar carcinoma.

CT Findings
Soft tissue mass in right upper lobe (5.5 x 3 x 6 cm), no enlarged mediastinal or axillary lymph nodes consistence with a primary lung malignancy.

Biopsy Findings
Interstitial fibrosis, inflammation, no evidence of metastatic carcinoma.

PET Findings
Triangular FDG uptake in the right upper lung (5.0 x 4 x 4.5 cm), uptake slightly less than typically seen in high grade malignancy re-biopsy recommended. Biopsy directed by PET finding adenocarcinoma of lung, bronchiolo-alveolar type.

Change in treatment plan
Evaluation of bilobectomy, pneumonectomy, chemotherapy.

Courtesy of
G. Ebert, MD, New England PET Imaging System, Methuen, MA