Case Author(s): Zhiyun Yang, M.D.and Farrokh, Dehdashti, M.D. , 03/25/05 . Rating: #D2, #Q3

Diagnosis: Sarcoidosis

Brief history:

50 year old woman with newly diagnosed cervical carcinoma presents for initial staging.

Images:

FDG-PET whole body. View MIP cine in AVI format.

View main image(pt) in a separate image viewer

View second image(pt). FDG-PET coronal image

View third image(pt). Fused image of PET and CT

View fourth image(bs). Whole body bone scintigraphy

Full history/Diagnosis is available below


Diagnosis: Sarcoidosis

Full history:

50 year old woman with newly diagnosed cervical carcinoma which is poorly differentiated adenocarcinoma with clear cell features on biopsy. The patient also has a history of sarcoidosis in the abdomen diagnosed in 1993 without any treatment. This study is for initial staging of cervical cancer.

Radiopharmaceutical:

14.4 mCi F-18 Fluorodeoxyglucose i.v.

Findings:

Tumor PET imaging demonstrated that focal uptake in the cervix posteriorly most likely consistent with the patient's known cervical carcinoma. Multiple lymph nodes throughout the entire body with mildly to moderately increased FDG uptake combined with multiple lytic lesions with moderately increased FDG uptake in the whole skeleton predominantly in the pelvis and increased FDG uptake in the spleen and pulmonary nodules. Bone scintigraphy demonstrated multiple foci of increased activity in the calvarium corresponding to a pattern of mixed lytic and sclerotic lesions on her skull radiographs.

Discussion:

In this case, given the fact of small cervical carcinoma with mildly increased FDG uptake, those above findings, especally the spleen demonstrating intense and heterogeneous FDG uptake, are less likely represent metastatic cervical carcinoma, other diagnosis such as sarcoidosis, lymphoma, and multiple myeloma should be considered.

Sarcoidosis is a disease that causes inflammation of the bodyís tissues. In sarcoidosis, the inflammation produces nodules or granulomas in the tissues. The inflammation of sarcoidosis can occur in almost any organ and always affects more than one. Most often, the inflammation starts in either the lungs or the lymph nodes.

Sarcoidosis occurs most commonly in adults between the ages of 20 and 40. The cause of sarcoidosis is not known; This diagnosis is what is known as a "diagnosis of exclusion". In general, if a person has moderate to severe symptoms or treatment is going to be given, tissue diagnosis is recommended.

Most people with sarcoidosis have no symptoms. Some have only one symptom, while still others have many. Symptoms typically depend on which organs the disease affects. In most patients, the inflammation that causes the granulomas gets better with or without treatment and the lumps go away. In others, however, the lumps do not heal or disappear, and the tissues remain inflamed. If untreated, these tissues can become scarred.

The treatment of sarcoidosis depends on a personís symptoms. 60% patients with sarcoidosis do not need treatment. But, for some patients, intense treatment is required, especially if there is critical organ involvement. Treatment is done to control symptoms or to improve the function of organs affected by the disease.

Sarcoidosis granulomas result from a response of the immune system. Thus, most medications used to treat sarcoidosis suppress the immune system. Treatment may or may not affect the long-term outcome of the disease.

Reference: Web site: U.S. Department of Health and Human Services.

Followup:

Biopsy of the skull lesion demonstrating noncaseating granulomas consistent with sarcoidosis.

Differential Diagnosis List

Metastatic cervical carcinoma,sarcoidosis, lymphoma, and multiple myeloma.

ACR Codes and Keywords:

References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Genitourinary System, Category:Inflammation,Infection)

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Case number: pt130

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