F-18 FDG PET Positive Hilar and Mediastinal Lymphadenopathy Mimicking Metastatic Disease in a Melanoma Patient Treated With Interferon-alpha-2b

Kalkanis, Dimitrios; Kalkanis, Alexandros; Gomaa, Osama; Paes, Fabio M.; Sfakianakis, George N.

doi:10.1097/rlu.0b013e318203bea5

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Imaging PET/CT false positives specific to radiationinduced liver injury in the setting of esophageal carcinoma have been reported (6)(7)(8). The causes are multifactorial and include: atypical infections (9), drug-reactions (10), co-existing neoplasms (11), immunotherapy (12), as well as proliferative connective tissue disorders (13). Given the breadth of potential etiologies and the importance of accurate staging, biopsy still holds great clinical value with an acceptable risk-benefit ratio when patient management would change.…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced hepatitis masquerading as metastatic disease: the importance of correlating diagnostic imaging with treatment planning

Parsee

McDonald

Jiang

et al. 2020

J Gastrointest Oncol

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We are presenting a 63-year-old Caucasian male who complained of 2 months of progressive dysphagia. Upper endoscopy discovered a mass in the distal esophagus near the gastroesophageal junction.Biopsy was consistent with adenocarcinoma. Endoscopic ultrasound (EUS) showed extension beyond the muscularis propria, with an enlarged paraesophageal lymph node (T3N1). Initial positron emission tomography (PET)/computed tomography (CT) showed hypermetabolic portocaval lymphadenopathy presumed to be metastatic, but otherwise without distant disease extension. Neoadjuvant treatment included induction FOLFOX followed by 5,600 cGy over 28 fractions in combination with 5-FU and oxaliplatin. Approximately 3.5 weeks after completion, a repeat PET/CT revealed reduced uptake in both the primary esophageal mass and regional lymph nodes. Of note there were several new mass-like foci of hypermetabolism in the liver, specifically the left lobe, concerning for metastatic disease. Image-guided biopsy did not show any identifiable lesions, but sampling was performed based on anatomical landmarks.Pathology revealed benign parenchyma with minimal inflammation and mild reactive regeneration. In light of this, the patient proceeded to undergo definitive resection via robotic Ivor-Lewis esophagectomy with only 1 positive lymph node. Given pleural involvement by the tumor, staging was revised to pT4aN1 with final histology characterized as adenosquamous carcinoma. Postoperative course was fairly uneventful, with a mild exacerbation of his chronic heart failure. The patient was discharged on post-operative day 7, with his feeding tube removed at his 2-week post-operative clinic visit. This scenario is of particular educational value from the standpoint that when the post-treatment PET/CT images are registered to the radiotherapy treatment planning CT and dose, the areas of abnormal uptake in the liver fall within the higher dose regions. Given this and the liver biopsy findings, caution should be exercised before declaring progressive disease following radiotherapy without first reviewing the treatment plan.

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Section: Discussionmentioning

confidence: 99%

Radiation-induced hepatitis masquerading as metastatic disease: the importance of correlating diagnostic imaging with treatment planning

Parsee

McDonald

Jiang

et al. 2020

J Gastrointest Oncol

View full text Add to dashboard Cite

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“…Pfanemberg et al [2] attribute an 89% specificity of the FDG PET/CT for the study of lymph nodes metastases of melanoma. Nevertheless, the SUVmax threshold should be interpreted with caution for diagnosing and treating lesions, since still there are numerous false positives non-tumoral conditions in the literature reporting this unresolved problem [4], [5], [6], [15], [16], [17], [18], [19]. This situation can cause misinterpretations in reading FDG PET/CT images.…”

Section: Discussionmentioning

confidence: 99%