Tumour thrombosis and patterns of fluorine-18 fluorodeoxyglucose uptake

Abstract

Tumour thrombosis (TT) is a very rare but serious complication in oncologic patients. The presence of TT has a significant impact on tumour staging, treatment decisions and prognosis in many malignancies. Current diagnostic techniques show poor ability to differentiate between bland and malignant thrombi; tumour thrombi are also usually inaccessible for biopsies, making their diagnosis difficult. In recent times, fluorine-18 fluorodeoxyglucose PET/computed tomography (F-FDG PET/CT) has well established its role in oncological imaging because of the high metabolic contrast of F-FDG between malignant and normal tissue. Patients with tumour thrombi may benefit from F-FDG PET/CT imaging when TT cannot be diagnosed precisely by other conventional imaging modalities. Here we provide a pictorial review of a few common and unusual sites of tumour thrombus in different malignancies and their patterns of F-FDG uptake.

Role of FDG PET-CT in Distinction of Benign Thrombus and Tumor Thrombus in Oncological Patients

“…TT is mostly an insidental finding in CECT. Tumor thrombus is rarely seen in solid tumors such as mostly in hepatocellular carcinoma (ca) and renal cell ca, followed by ovarian/testicular tumors, colon ca, pancreas ca, lung, breast, thyroid tumors, lymphomas, sarcomas, neuroendocrine tumors [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Maximum standardized uptake value (SUVmax) is semiquantitative parameter that reflect metabolic activity, but is not specific marker of malignancies.…”

Uncommon Testicular Germ Cell Tumor Thrombus in Azygos Vein Detected by FDG PET/CT

“…PET/CT has a potential for differentiation of tumoral and bland thrombus. Diagnosis of tumoral thrombosis is also important to prevent undesired anticoagulation 1,6–8 . In our case, anticoagulant treatment was added to etoposide and cisplatin regimen by the medical oncology department after the involvement of the venous system.…”

“…Venous tumor thrombosis incidence is increased in testicular tumors 1–4 . However, the usual sites for tumor thrombosis include testicular vein, left renal vein, and/or inferior vena cava, which comprises the testicular vein drainage pathway 3,5,6 . Tumoral thrombus in the azygos vein is extremely rare 5,7 .…”

“…[1][2][3][4] However, the usual sites for tumor thrombosis include testicular vein, left renal vein, and/or inferior vena cava, which comprises the testicular vein drainage pathway. 3,5,6 Tumoral thrombus in the azygos vein is extremely rare. 5,7 There are 2 cases of azygos vein tumor thrombosis related to renal cell carcinoma reported in the literature.…”

Case of carcinoma breast with unusually large tumor thrombus in superior vena cava detected on 18F-fluorodeoxyglucose positron emission tomography computed tomography scan

“…TT is more commonly associated with hepatocellular carcinoma, renal cell carcinoma, and gonadal tumors. [ 7 ] Among the sites of TT, most common is inferior vena cava, followed by portal and renal veins. [ 8 ] SVC is a relatively rare site of TT although few case reports exist.…”