Lung Cancer - Small Cell Lung Carcinoma Case 1

Clinical History
A 71 year old woman presented with small cell lung carcinoma with a left upper mediastinal mass. The patient had a chest X-ray at a routine check up, which revealed hilar fullness on the left side. She was referred for a thoracic CT study, which revealed a large soft tissue mass in the left side upper mediastinum, measuring 4.2 x 4.1 cm in size. There was possible invasion of the pericardium. Small pulmonary nodules in left lower lobe and several low attenuation areas in the liver were suggestive of metastases.

An FDG PET•CT scan was ordered for comprehensive staging and to evaluate the patient for additional metastases.

Imaging Findings*


  

The FDG PET•CT study showed a hypermetabolic left upper mediastinal mass measuring 48 mm with internal necrosis. There was also a hypermetabolic 19 mm mediastinal metastatic nodal aggregate in the aortopulmonary window. The left hilum also showed metastatic nodal aggregate. There was obstructive atelectasis extending anteriorly, with the tumor tracking into the atelectatic segment.

The FDG PET•CT scan also showed multiple hypermetabolic hepatic metastases with the largest in the anterior aspect of the mid right lobe of the liver, measuring 29 mm in size. Altogether 6 liver metastases were visualized.

The FDG PET•CT study also showed multiple hypermetabolic skeletal metastases including the left acetabulum, and the bilateral iliac bones. There were several lesions in the lumbar and thoracic vertebrae, the ribs, both humeral heads and the proximal right humerus. The CT portion of the scan demonstrated minor lytic changes in the vertebral and iliac metastases.

Discussion
The FDG PET•CT study demonstrated the true extent of the primary tumor and metastatic disease. Evidence of hilar, hepatic and skeletal metastases on PET•CT was critical in correctly staging the patient and for the correct decision concerning chemotherapy.

Data courtesy of Mike Medeiros, Chief Technologist, Western Washington Oncology, Lacey, WA

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.