Case Author(s): Gregg D. Schubach, M.D., Philip Moyers, M.D., and Farrokh Dehdashti, M.D. , . Rating: #D3, #Q3

Diagnosis: Primary Pancreatic Carcinoma with metastatic lung carcinoma to left adrenal

Brief history:

58-year old man status post surgically resected right upper lobe adenocarcinoma has two abnormalities on a recent CT study of the abdomen.


Anterior and slight RPO projections from PET study

View main image(pt) in a separate image viewer

View second image(ct). Axial CT image from level of pancreas

View third image(ct). Axial CT image from level of adrenal

Full history/Diagnosis is available below

Diagnosis: Primary Pancreatic Carcinoma with metastatic lung carcinoma to left adrenal

Full history:

58-year old man status post surgically resected right upper lobe adenocarcinoma and radiation therapy has a pancreatic head mass and left adrenal mass on a recent CT study of the abdomen.


F-18 Fluorodeoxyglucose


FDG whole body PET imaging demonstrates markedly increased FDG accumulation in the pancreatic head (on the anterior image) and in the left adrenal gland (on the posterior image). The CT images demonstrate a soft tissue mass in the head of the head of the pancreas and a nodule in the left adrenal gland.


Positron emission tomography (PET) is a unique imaging modality that obtains functional imaging data from the human body. The count density in reconstructed PET images, unlike other radionuclide imaging techniques, is directly proportional to the local radioactivity concentration. Therefore, tracer uptake may be absolutely quantified. PET plays a complementary role to other imaging modalities, such as magnetic resonance imaging (MRI) or computed tomography (CT), which mainly provide anatomic rather than functional information. Functional changes may proceed anatomic changes in many disorders, such as Alzheimeršs disease, Parkinsonšs disease, Huntingtonšs disease, neurodevelopmental disorders, psychiatric disorders, epilepsy, cardiomyopathies, coronary artery disease, and a whole host of malignancies.

The clinical oncologic applications of PET, while not as well developed as cardiac and neurologic applications, appear very promising and most investigators foresee several major clinical applications within the next five years. Fluorodeoxyglucose (FDG)-PET studies have high sensitivity, specificity, and accuracy for evaluating radiologically indeterminate solitary pulmonary nodules and accuracy in staging lung tumors. Differentiating residual post-surgical scar from persistent tumor is a common clinical problem, which PET may resolve. Gupta, et al. and Knapp, et al., in separate studies, demonstrate 100% specificity in their studies of 19 and 18 patients, respectively.

Potential indications for PET in clinical oncology during initial evaluation include: 1) differentiating benign from malignant lesion; 2) determining degree of malignancy; 3) localizing site for biopsy; 4) staging; and 5) assessing prognosis. Following therapy, the clinical indications for PET include: 1) documenting recurrence; 2) assessing persistence; 3) determining effectiveness of treatment; and 4) monitoring progression.

References: Coleman, R.E., editor, The Radiologic Clinics of North America, July 1993 31:4 2) Sandler, M.P., et al. Diagnostic Nuclear Medicine, 3rd edition, 1996. Williams and Wilkins


Biopsy of the left adrenal nodule under CT guidance revealed adenocarcinoma (most compatible with pancreatic adenocarcinoma primary). The metastatic adrenal adenocarcinoma is likely from the bronchogenic carcinoma in this patient, although it could be from pancreatic carcinoma.

Differential Diagnosis List

Increased FDG uptake is not as specific for malignancy and can be seen in pheochromocytomas.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Gasterointestinal System, Category:Neoplasm, Neoplastic-like condition)

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Case number: pt009

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