PET-CT case of the month (12/09): Head and Neck Cancer
73 yrs old male presented with painless left neck mass. A contrast enhanced
CT of the neck showed necrotic left level II cervical lymphadenopathy
concerning for metastatic disease, and a 1.7 x 1.5 cm mass arising from the
superficial lobe of the right parotid gland. A 1.2 cm nodule was also visualized
in the right lung apex. FNA of the enlarged cervical lymph node showed
metastatic keratinizing squamous cell carcinoma.
CT of the neck showed necrotic left level II cervical lymphadenopathy
concerning for metastatic disease, and a 1.7 x 1.5 cm mass arising from the
superficial lobe of the right parotid gland. A 1.2 cm nodule was also visualized
in the right lung apex. FNA of the enlarged cervical lymph node showed
metastatic keratinizing squamous cell carcinoma.
Whole body FDG-PET CT showed asymmetric uptake in the left tonsil with a
maximum SUV of 8.6. Hypermetabolic left cervical level II lymphadenopathy
had a maximum SUV of 6.9. Indeterminate focal hypermetabolism was seen
in the right parotid gland with a maximum SUV of 6.0. The right upper lobe
pulmonary nodule also showed hypermetabolism (SUV 3.9) suspicious for
neoplastic involvement.
maximum SUV of 8.6. Hypermetabolic left cervical level II lymphadenopathy
had a maximum SUV of 6.9. Indeterminate focal hypermetabolism was seen
in the right parotid gland with a maximum SUV of 6.0. The right upper lobe
pulmonary nodule also showed hypermetabolism (SUV 3.9) suspicious for
neoplastic involvement.
1. FDG PET and PET/CT for the detection of the primary tumour in patients
with cervical non-squamous cell carcinoma metastasis of an unknown
primary. Paul SA, Stoeckli SJ, von Schulthess GK, Goerres GW. Eur Arch
Otorhinolaryngol. 2007 Feb;264(2):189-95.
2. The presentation of malignant tumours and pre-malignant lesions
incidentally found on PET-CT. Even-Sapir E, Lerman H, Gutman M,
Lievshitz G, Zuriel L, Polliack A, Inbar M, Metser U. Eur J Nucl Med Mol
Imaging. 2006 May;33(5):541-52.
This case was compiled by Dr. Scott Lenobel, BCM
with cervical non-squamous cell carcinoma metastasis of an unknown
primary. Paul SA, Stoeckli SJ, von Schulthess GK, Goerres GW. Eur Arch
Otorhinolaryngol. 2007 Feb;264(2):189-95.
2. The presentation of malignant tumours and pre-malignant lesions
incidentally found on PET-CT. Even-Sapir E, Lerman H, Gutman M,
Lievshitz G, Zuriel L, Polliack A, Inbar M, Metser U. Eur J Nucl Med Mol
Imaging. 2006 May;33(5):541-52.
This case was compiled by Dr. Scott Lenobel, BCM
Biopsy of the left tonsil showed squamous cell carcinoma and the biopsy of
right parotid gland showed pleomorphic adenoma, a benign tumor.
The right upper lobe pulmonary nodule was biopsied and showed non small
cell carcinoma with features of adenocarcinoma.
Thus, PET-CT localized the primary squamous cell carcinoma to left tonsil
and diagnosed an incidental second primary malignancy in the lung.
right parotid gland showed pleomorphic adenoma, a benign tumor.
The right upper lobe pulmonary nodule was biopsied and showed non small
cell carcinoma with features of adenocarcinoma.
Thus, PET-CT localized the primary squamous cell carcinoma to left tonsil
and diagnosed an incidental second primary malignancy in the lung.
