Case Author(s): Michael C. Roarke, M.D. and Barry A. Siegel, M.D. , 8/7/95 . Rating: #D3, #Q4
Diagnosis: Metastatic renal cell carcinoma.
Brief history:
56-year old woman diagnosed
with renal cell carcioma in January 1995. Right
nephrectomy was performed in February 1995.
Subsequently, a right lower lobe lung mass was noted
on the chest radiograph dated 6-19-95. This
examination was requested to evaluate for other
metastatic disease.
Images:
F-18 fluorodeoxyglucose (FDG) imaging of the body was performed.
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View second image(ct).
Axial image of the upper chest at the cervico-thoracic junction.
Full history/Diagnosis is available below
Diagnosis: Metastatic renal cell carcinoma.
Full history:
56-year old woman diagnosed
with renal cell carcinoma in January 1995. Right
nephrectomy was performed in February 1995.
Subsequently, a right lower lobe lung mass was noted
on the chest radiograph dated 6-19-95. This
examination was requested to evaluate for other
metastatic disease.
Radiopharmaceutical:
15 mCi F-18
fluorodeoxyglucose (FDG)
Findings:
The PET study shows abnormally
increased F-18 FDG uptake in the upper thoracic
spine at the T2 level. Other images (not included) also showed
increased activity in the lumbar spine at
approximately the L2 level. These areas were
considered consistent with metastatic disease. The
findings in the thoracic spine correlate with those seen on
the computed tomography scan
dated 6-29-95, which demonstrates a lytic lesion
involving the T2 vertebral body and extending into the left
T2 pedicle and transverse process.
Discussion:
FDG is a glucose analogue,
which enters cells via the glucose cell-membrane
transporter. Once within the cell, FDG is
phosphorylated by hexokinase. Further metabolism
within the cell does not occur, however. The FDG in
its phosphorylated state is trapped within the cell.
Since many neoplasms demonstrate increased
glycolysis and, hence, increased glucose uptake, this
tracer serves to help in the identification of neoplastic
tissue within the body.
References: Warburg, Otto. On the
original of cancer cells, published in Science 2-24-56,
volume 123, page 309-314.
ACR Codes and Keywords:
References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Spine and Contents, Category:Neoplasm, Neoplastic-like condition)
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Case number: pt002
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