The patient is a 78 year old man with a history of a left neck glomus tumor
diagnosed about 10 yrs ago, presented with complaints of worsening left thigh
pain. X-ray showed a 2.4 cm lytic lesion in proximal left femur. CT-guided
biopsy demonstrated metastatic neuroendocrine tumor.
diagnosed about 10 yrs ago, presented with complaints of worsening left thigh
pain. X-ray showed a 2.4 cm lytic lesion in proximal left femur. CT-guided
biopsy demonstrated metastatic neuroendocrine tumor.
Case of the month (06/10): Metastatic Carotid Body Tumor
A whole body FDG PET-CT showed intense focal hypermetabolism (SUV max
26) in the large left neck mass extending from the base of the skull to the
superior aspect of the hyoid bone, invading the left petrous temporal bone, and
encasing the internal carotid artery and jugular vein. Hypermetabolism was
also seen in left level IIb lymph nodes (SUV max 9.5), a 1.4 cm nodule in the
right lung base (SUV max 6.4), and a lytic lesion in the left proximal femur (SUV
max 18.0).
26) in the large left neck mass extending from the base of the skull to the
superior aspect of the hyoid bone, invading the left petrous temporal bone, and
encasing the internal carotid artery and jugular vein. Hypermetabolism was
also seen in left level IIb lymph nodes (SUV max 9.5), a 1.4 cm nodule in the
right lung base (SUV max 6.4), and a lytic lesion in the left proximal femur (SUV
max 18.0).
A subsequent In-111 Octreotide scan showed increased tracer uptake in the
left neck mass and femur, but not in the cervical lymph nodes or lung nodule.
More metastatic lesions were seen on the FDG PET-CT compared to the
Octreotide SPECT-CT. In the interim patient also had open reduction and
internal fixation at the left femur.
left neck mass and femur, but not in the cervical lymph nodes or lung nodule.
More metastatic lesions were seen on the FDG PET-CT compared to the
Octreotide SPECT-CT. In the interim patient also had open reduction and
internal fixation at the left femur.
Carotid body tumors are paragangliomas (extra-adrenal pheochromocytomas)
arising from the carotid body. They arise close to or envelop the bifurcation of
common carotid artery, usually in the sixth decade of life, and may be familial
with autosomal dominant transmission in MEN 2 syndrome. They frequently
recur after resection, many metastasize, and 50% ultimately prove fatal by
direct invasion.
1. FDG PET imaging of paragangliomas of the neck: comparison with MIBG
SPET. Macfarlane DJ, Shulkin BL, Murphy K, Wolf GT. Eur J Nucl Med. 1995
Nov;22(11):1347-50.
2. PET scan assessment of chemotherapy response in metastatic
paraganglioma. Argiris A, Mellott A, Spies S. Am J Clin Oncol. 2003
Dec;26(6):563-6.
This case was compiled by Dr. Matthew R. Galfione, BCM
arising from the carotid body. They arise close to or envelop the bifurcation of
common carotid artery, usually in the sixth decade of life, and may be familial
with autosomal dominant transmission in MEN 2 syndrome. They frequently
recur after resection, many metastasize, and 50% ultimately prove fatal by
direct invasion.
1. FDG PET imaging of paragangliomas of the neck: comparison with MIBG
SPET. Macfarlane DJ, Shulkin BL, Murphy K, Wolf GT. Eur J Nucl Med. 1995
Nov;22(11):1347-50.
2. PET scan assessment of chemotherapy response in metastatic
paraganglioma. Argiris A, Mellott A, Spies S. Am J Clin Oncol. 2003
Dec;26(6):563-6.
This case was compiled by Dr. Matthew R. Galfione, BCM
