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Cape HT, Gupta L, Blanchard CC, Raslau FD, Timoney PJ. Tumor versus bland thrombus: diffuse large B-cell lymphoma presenting as cavernous sinus and left superior ophthalmic vein thrombosis. Orbit 2025; 44:348-352. [PMID: 39192768 DOI: 10.1080/01676830.2024.2393416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/11/2024] [Indexed: 08/29/2024]
Abstract
A 66-year-old female with a history of sinusitis presented with persistent diplopia and worsening eyelid swelling. Examination revealed bilateral vision loss, cranial nerve palsies, left-sided chemosis, proptosis, and edema. Initial imaging showed sphenoid sinus opacification, bilateral ethmoid disease, lack of filling of bilateral cavernous sinuses, and partial thrombosis of the left superior ophthalmic vein. The sinus findings were evaluated with endoscopic sinus surgery, which was unremarkable. Subsequent orbital imaging suggested the lesions were in keeping with tumor thrombus as opposed to bland thrombus. CT scans revealed a large mass in the right axilla, which was biopsied and confirmed the diagnosis of diffuse large B-cell lymphoma (DLBCL). The patient was treated with anticoagulation, steroids, and chemotherapy resulting in marked improvement. Our report highlights a rare case of tumor thrombus from DLBCL causing bilateral cavernous sinus thrombosis and, to the best of our knowledge, the first documented case of superior ophthalmic vein thrombosis from tumor thrombus.
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Affiliation(s)
- Hays T Cape
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Lalita Gupta
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Cody C Blanchard
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Flavius D Raslau
- Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Peter J Timoney
- Department of Ophthalmology and Visual Sciences, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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2
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Bary AA, Murugesan K, Krishnan CK, SunderSingh S, Raja A. Management Strategies and Outcomes of Tumor Thrombus in Extremity Osteosarcoma. Asia Pac J Clin Oncol 2025. [PMID: 40384560 DOI: 10.1111/ajco.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Osteosarcoma, accounting for 2.4% of all childhood malignancies and about 20% of primary bone cancers, primarily affects young adults, with 60% of cases occurring before age 25. Tumor thrombus (TT) formation, a type of cancer-associated thrombosis, is a rare but critical complication in osteosarcoma, leading to increased morbidity and mortality. TT is characterized by the direct extension of the tumor into adjacent vessels, displaying similar imaging characteristics and contrast enhancement as the primary tumor. Our study is a case series of five cases of extremity osteosarcoma where the presence of tumor thrombus has been diagnosed, highlighting diagnostic challenges and management strategies. Preoperative identification of TT remains difficult and is often diagnosed postoperatively or at autopsy. Advanced imaging techniques such as Computed Tomography, Magnetic Resonance Imaging, and Positron Emission Tomography can aid in the detection of TT, although they are not definitive. Surgical resection combined with thrombectomy is recommended, improving prognosis. Anticoagulation therapy aims to prevent bland thrombus formation rather than resolving TT, as the latter increases the risk of embolization. This study underscores the need for heightened suspicion and comprehensive preoperative imaging to improve outcomes in osteosarcoma patients with TT, advocating for multidisciplinary management including vascular surgeons during limb salvage procedures. Further research is essential to optimize anticoagulation protocols and validate these findings in larger cohorts.
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Affiliation(s)
- Ashik A Bary
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
| | | | | | | | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, India
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3
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Datta D, Kumar R, Goel AD. Utility of metabolic ratios in the diagnosis of tumor Thrombus on F-18 FDG PET/CT. EJNMMI REPORTS 2024; 8:12. [PMID: 38748073 PMCID: PMC11076428 DOI: 10.1186/s41824-024-00201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/24/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND This study aims to predict quantitative parameter in form of metabolic ratios to diagnose tumor thrombus on F-18 FDG PET/CT. METHODS This is a retrospective study from Nuclear Medicine department at All India Institute of Medical Sciences, Jodhpur, India. Patients with malignancies who underwent F-18 FDG PET/CT in our department or images sent for review from February 2020 till September 2022 were screened for tumor thrombus that comprised study group. Control group had patients with malignancy and no imaging evidence of tumor thrombus. Metabolic activities (SUVmax) of tumor thrombus, liver and descending aorta in study group, and that of IVC, liver and descending aorta in control group were recorded. Metabolic ratios of tumor thrombus to liver (SUR L) and to aorta (SUR A) in study group, and IVC to liver (SUR* L) and to aorta (SUR*A) in control group were compared using receiver operator curves. RESULTS Of 2277 studies screened, 12 had tumor thrombus. The most common primary malignant site and vessel involved were lung and IVC respectively. The median (IQR) SUR L, SUR A, SUR* L and SUR* A were 2.5 (3.25), 2.6 (6), 0.67 (0.18) and 1 (0.17) respectively. Area under ROC for SUR L and SUR A were 0.983 [95% CI: 0.955-1.0] and 0.958 [95% CI: 0.90-1.0] respectively. The ideal cut-off for SUR L was 0.953 (sensitivity 92.3%, specificity 98.0%) and for SUR A was 1.42 (sensitivity 84.6%, specificity 98.0%). CONCLUSION Metabolic ratios of tumor thrombus to liver (SUR L) and aorta (SUR A) have good diagnostic performance and can be useful in studies with non-iodinated contrast CT.
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Affiliation(s)
- Deepanksha Datta
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rajesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India.
| | - Akhil Dhanesh Goel
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Pooyan A, Mansoori B, Wang C. Imaging of abdominopelvic oncologic emergencies. Abdom Radiol (NY) 2024; 49:823-841. [PMID: 38017112 DOI: 10.1007/s00261-023-04112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/30/2023]
Abstract
With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes.
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Affiliation(s)
- Atefe Pooyan
- Department of Radiology, UW Radiology-Roosevelt Clinic, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
| | - Bahar Mansoori
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA
| | - Carolyn Wang
- Department of Radiology, Section of Abdominal Imaging, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-7115, USA.
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5
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Ng HZA, Cheng LTJ, Ngam PI, Sinha AK, Loi HY. Lymphoma Masquerading as Lung Cancer. Clin Nucl Med 2023; 48:520-521. [PMID: 37133511 DOI: 10.1097/rlu.0000000000004636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
ABSTRACT Lymphoma typically manifests as lymphadenopathy, with or without solid organ involvement. Lymphomatous masses tend to respect anatomical structures, encasing rather than invading them. Tumor thrombus formation is a rare presentation in lymphoma that has been previously described in the liver and kidneys. We report an unusual presentation of B-cell lymphoma with imaging findings suggestive of metastatic lung cancer with tumor thrombus in the pulmonary vein and left atrium.
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Vidula MK, Han Y, Litt H, Bravo PE. Left ventricular mural thrombus appearing as a photopenic defect on myocardial viability PET imaging. J Nucl Cardiol 2022; 29:2713-2715. [PMID: 33403514 DOI: 10.1007/s12350-020-02480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Mahesh K Vidula
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
| | - Yuchi Han
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
- Division of Cardiothoracic Imaging, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
| | - Harold Litt
- Division of Cardiothoracic Imaging, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
| | - Paco E Bravo
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
- Division of Cardiothoracic Imaging, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
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Tariq A, McGeorge S, Pearce A, Rhee H, Wood S, Kyle S, Marsh P, Raveenthiran S, Wong D, McBean R, Westera J, Dunglison N, Esler R, Navaratnam A, Yaxley J, Thomas P, Pattison DA, Roberts MJ. Characterization of tumor thrombus in renal cell carcinoma with prostate specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT). Urol Oncol 2022; 40:276.e1-276.e9. [DOI: 10.1016/j.urolonc.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
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Sweedat DA, Al-Hajaj N, Khzouz J, Al-Ibraheem A. Renal Spindle Cell Tumor with Thrombus Extension into the Inferior Vena Cava and the Right Atrium Depicted by PET/CT Scan. World J Nucl Med 2022; 21:59-61. [PMID: 35502284 PMCID: PMC9056133 DOI: 10.1055/s-0042-1744199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractTumor thrombus (also called intravascular tumor extension) can be defined as tumor extending into vessel; typically a vein, it occurs in a lot of malignancies like hepatocellular carcinoma, Wilms tumor, and others.1 Tumor thrombus has been reported to demonstrate increase in fluorine-18 fluorodeoxyglucose (FDG) uptake that would differentiate it from the benign bland thrombus which would not take up FDG on positron emission tomography/computed tomography (PET/CT) scan.1 We present a case of spindle cell sarcoma of right kidney whose baseline contrast-enhanced CT revealed a mass replacing the right kidney and right renal vein associated with thrombus in the inferior vena cava (IVC). 18F-FDG PET/CT imaging was done that revealed an FDG-avid hypermetabolic malignant right renal mass with hypermetabolic IVC thrombus extending to the right atrium.
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Affiliation(s)
| | - Nabeela Al-Hajaj
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Jakub Khzouz
- Department of Histopathology, King Hussein Cancer Center, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
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9
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Value of 18F-FDG PET/CT Combined with Lung HRCT in Diagnosis of Solitary Pulmonary Intravascular Metastasis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8968855. [PMID: 35280706 PMCID: PMC8885262 DOI: 10.1155/2022/8968855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
Abstract
Background Solitary pulmonary intravascular metastasis is a rare complication of malignant tumors, and accurate diagnosis can improve clinical decision-making, but diagnosing it effectively using conventional techniques is difficult. Purpose To explore the value of 18F-FDG PET/CT combined with lung high-resolution computed tomography (HRCT) in the diagnosis of solitary pulmonary intravascular metastasis. Methods 18F-FDG PET/CT, lung HRCT, and follow-up data of 18,143 cancer patients were retrospectively analyzed to select patients with pulmonary vessel involvement besides the primary tumor only. The histopathological or imaging follow-up results were used as the diagnostic criteria for pulmonary intravascular metastasis. Results A total of 13 patients with 17 pulmonary intravascular metastases were found, of which 9 patients had a single lesion and 4 had double. The SUVmax was 1.1–5.4 (average, 2.4 ± 1.4), and the length of hypermetabolic metastasis was 5.1–24.1 mm (average, 10.7 ± 6.5 mm). All the intravascular metastases were located in the terminal pulmonary vessels. Strip or branched pulmonary vessels enlargement with increased metabolism was the main imaging manifestation (15/17, 88.2%), while the other 2 cases only showed strip metabolic enhancement without abnormalities in pulmonary vessels (2/17, 11.8%). Four pulmonary intravascular metastases were confirmed by pathology, and the other 13 cases were diagnosed by imaging follow-up. Conclusion 18F-FDG PET/CT combined with lung HRCT is an effective technique for the diagnosis of solitary pulmonary intravascular metastasis. High-strip or branched FDG uptake in the distal pulmonary vessel accompanied by corresponding morphological changes in patients with malignant tumors can be used as a specific diagnostic indicator.
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10
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Al-Ibraheem A, Sweedat D, Al-Hajaj N, Khzouz J. Renal spindle cell tumor with thrombus extension into the inferior vena cava and the right atrium depicted by positron emission tomography/computerized tomography scan. World J Nucl Med 2022. [DOI: 10.4103/wjnm.wjnm_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Diagnostic Value of FDG PET/CT and Thin-Slice High-Resolution Chest CT in Pulmonary Intravascular Metastasis. AJR Am J Roentgenol 2021; 216:769-775. [PMID: 33405948 DOI: 10.2214/ajr.20.23017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Pulmonary intravascular metastasis is a special type of pulmonary metastasis of malignancies; however, few relevant studies have been performed. This study aimed to determine the characteristics of pulmonary intravascular metastasis and improve understanding of the disease by retrospective analysis of FDG PET/CT and thin-layer high-resolution CT (HRCT) imaging of the chest in patients with tumors. MATERIALS AND METHODS. We identified all patients who underwent FDG PET/CT at two hospitals between January 2016 and February 2019 and conducted a comparative analysis of HRCT and PET/CT images. In total, 84 patients (38 women and 46 men) ranging in age from 35 to 82 years old (mean age, 54.7 ± 14.5 [SD] years) participated in the study. Patient characteristics were summarized, and diagnosis was confirmed by chest CT or PET/CT follow-up. RESULTS. A total of 260 pulmonary intravascular metastases were found, which were classified as type I (no significant abnormality, n = 5), type II (abrupt and uneven thickening of the pulmonary vessel, n = 118), type III (simultaneous invasion of adjacent pulmonary vessel, n = 121), and type IV (large strip-shaped high-density mass, n = 16). The majority were located in peripheral pulmonary vessels (94.2% [245/260]). FDG up-take was increased in 252 lesions, and the mean SUVmax was 4.6 ± 2.5. CONCLUSION. The combination of PET/CT and chest HRCT is an effective approach for detecting pulmonary intravascular metastasis. The linear pattern of FDG uptake, abnormal pulmonary blood vessel morphology, and location (below the lung segment) are specific indicators for the diagnosis of pulmonary intravascular metastasis and should be recognized by clinicians and radiologists.
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12
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Greally M, Pilson K, Linehan A, O'Keane C, Shields CJ, Conneely JB, McCaffrey JA. Indolent Nodal Relapse of Colon Carcinoma with Associated Tumor Thrombus Invading the Superior Mesenteric Vein. J Gastrointest Cancer 2020; 50:660-664. [PMID: 29663116 DOI: 10.1007/s12029-018-0101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Megan Greally
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. .,Gastrointestinal Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Keith Pilson
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Anna Linehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor O'Keane
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor J Shields
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John B Conneely
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John A McCaffrey
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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Lad PP, Kumar J, Sarvadnya J, Powar AS. Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium - A case report. Int J Surg Case Rep 2019; 66:48-52. [PMID: 31805428 PMCID: PMC6909162 DOI: 10.1016/j.ijscr.2019.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Differentiated thyroid carcinoma with an extensive intravenous tumor thrombus which is extending into internal jugular vein (IJV), superior vena cava (SVC) and right atrium (RA) is a rare clinical finding. We report a multimodal staged surgical approach for this life threatening complicated case. PRESENTATION OF CASE A 52 year old female, presented with diffuse thyroid swelling, FNAC revealed it as follicular thyroid neoplasm. Computed tomography (CT) scan showed tumor thrombus extending into IJV, SVC and right atrium (RA). We planned complete resection of tumor in two stage operation. Initially in first stage, cardio-thoracic surgery was done to remove SVC and RA thrombus to eliminate the immediate risk of pulmonary embolism. In the second stage, neck surgery was performed to resect thyroid tumor and to perform extensive thrombectomy in the cervical veins. This patient has been followed for one year after successful surgery without recurrence. DISCUSSION Venous involvement by follicular thyroid carcinoma reaching to RA is a rare life threatening condition. Though there is no standard guidelines available, treatment strategies should be discussed and planned among multidisciplinary team. Intraluminal extension is not a contraindication for aggressive surgical management. It will avoid fatal pulmonary embolism, as well as improve overall survival of the patient. CONCLUSION Invasion of the great vessels by thyroid carcinoma is usually associated with early relapse and poor prognosis, but if tumor in the blood vessel is resected completely, a better prognosis is possible. Two staged surgical approach is safe and gives a predictable outcome.
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Affiliation(s)
- Prashant Praksh Lad
- Department of Surgical Oncology, Om Sai Onco-Surgery Center, R/S no 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, 416006, India.
| | - Jateendar Kumar
- Sai Cardiac Center, 2021/B, 6th lane S.T Colony, Mahalaxminagar, Rajarampuri, Kolhapur, Maharashtra, 416008, India.
| | - Jagadish Sarvadnya
- Department of Head and Neck Surgery, Om Sai Onco-Surgery Center, R/S number 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, 416006, India.
| | - Abhijit S Powar
- Department of Surgical Oncology, Om Sai Onco-Surgery Center, R/S number 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, 416006, India.
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Burkitt Lymphoma Presenting With Intracardiac Mass and Tumor Thrombosis in the Anterior Mediastinum With Literature Review. J Pediatr Hematol Oncol 2019; 41:e197-e200. [PMID: 30299348 DOI: 10.1097/mph.0000000000001327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Burkitt lymphoma manifesting as an intracardiac mass is a rare entity. This report describes the case of a 10-year-old boy who presented with an intracardiac mass and tumor thrombosis in the anterior mediastinum that proved to be Burkitt lymphoma. The LMB-96 chemotherapy protocol was given and at the end of the treatment there was still residual mass. A biopsy was performed and the pathology revealed thymus tissue. The patient has been in complete remission for 3 months. Burkitt lymphoma has a short doubling time and an intracardiac lesion can become life threatening. Early recognition and prompt treatment are crucial in achieving optimal outcomes.
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Doroudinia A, Ahmadi S, Mehrian P, Pourabdollah M. Primary Ewing sarcoma of the kidney. BMJ Case Rep 2019; 12:12/1/bcr-2018-227198. [PMID: 30696641 DOI: 10.1136/bcr-2018-227198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Primary Ewing sarcoma (ES) or primitive neuroectodermal tumour (PNET) is a rare tumour in adults and primary renal involvement is extremely rare. Patients with renal ES or PNET respond to and would benefit from conventional ES treatment according to ES study protocols. Here, we report a case of a young woman, presenting with right flank pain and haematuria. After ultrasound and CT evaluation, a right middle pole renal mass was detected. The patient underwent radical right nephrectomy, and a grade 4 ES with peritoneal involvement was documented. Subsequently, the patient underwent adjuvant chemotherapy for 5 months. Follow-up 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan demonstrated bilateral cervical, hilar, mediastinal and retroperitoneal FDG-avid adenopathies associated with mild right-sided pleural effusion with no metabolic activity, signifying the role of PET/CT scan in tumour restaging.
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Affiliation(s)
- Abtin Doroudinia
- PET/CT, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Sara Ahmadi
- PET/CT, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Payam Mehrian
- Radiology, Telemedicine Research Center (TRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Mihan Pourabdollah
- Pathology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, The Islamic Republic of Iran
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Zaman MU, Fatima N, Zaman A, Zaman U, Tahseen R, Zaman S. Massive Tumor Thrombus in Left Renal Vein and Inferior Vena Cava in Renal Cell Carcinoma on 18-fluorodeoxyglucose Positron Emission Tomography/computerized Tomography: "Suspension Bridge Sign". World J Nucl Med 2018; 17:120-122. [PMID: 29719488 PMCID: PMC5905257 DOI: 10.4103/wjnm.wjnm_30_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tumor thrombosis is a relatively uncommon complication of renal cell carcinoma (RCC), and its diagnosis has therapeutic and prognostic implication. Computerized tomography (CT) is the primary imaging modality for staging RCC, but it has low sensitivity to differentiate between tumor thrombus and bland or benign thrombus. 18-fluorodeoxyglucose positron emission tomography/CT (PET/CT) has a limited role in diagnosis and staging of RCC, but its diagnostic accuracy is considerably high for detection of metabolically active tumor thrombus. We are presenting a case of metastatic left-sided RCC with massive hypermetabolic tumor thrombus extending from left kidney to left renal vein and inferior vena cava giving an interesting "Suspension Bridge" appearance on PET/CT images.
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Affiliation(s)
- Maseeh Uz Zaman
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Nosheen Fatima
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Areeba Zaman
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Unaiza Zaman
- Department of Medicine, Civil Hospital, Karachi, Pakistan
| | - Rabia Tahseen
- Department of Medicine, Civil Hospital, Karachi, Pakistan
| | - Sidra Zaman
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Rustagi T, Gleeson FC, Chari ST, Abu Dayyeh BK, Farnell MB, Iyer PG, Kendrick ML, Pearson RK, Petersen BT, Rajan E, Topazian MD, Truty MJ, Vege SS, Wang KK, Levy MJ. Remote malignant intravascular thrombi: EUS-guided FNA diagnosis and impact on cancer staging. Gastrointest Endosc 2017; 86:150-155. [PMID: 27773725 DOI: 10.1016/j.gie.2016.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/09/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Malignant vascular invasion usually results from gross direct infiltration from a primary tumor and impacts cancer staging, prognosis, and therapy. However, patients may also develop a remote malignant thrombi (RMT), defined as a malignant intravascular thrombus located remote and noncontiguous to the primary tumor. Our aim was to compare EUS, CT, and magnetic resonance imaging (MRI) findings of RMT and to explore the potential impact on cancer staging. METHODS Patients with RMT were identified from a prospectively maintained EUS database. Retrospective chart review was performed to obtain EUS, CT/MRI, clinical, and outcome data. RESULTS A median of 3 FNAs (range, 1-8) was obtained from RMT in 17 patients (60 ± 14.1 years, 56% men) between April 2003 and August 2016, with the finding of malignant cytology in 12 patients (70.6%; 10 positive, 2 suspicious). CT/MRI detected the RMT in 5 patients (29.4%), 4 of whom had positive or suspicious EUS-FNA cytology. Among the 8 newly diagnosed pancreatic adenocarcinoma (PaC) patients, CT did not detect the RMT in 5 (63%), of whom 3 patients had positive or suspicious intravascular EUS-FNA cytology. For newly diagnosed PaC patients (n = 8), the EUS-FNA diagnosis of a biopsy specimen-proven RMT upstaged 3 patients (37.5%) and converted 2 patients (25%) from CT resectable to unresectable disease. No adverse events were reported. The mean follow-up was 18.9 ± 27.7 months. CONCLUSIONS Our study demonstrates the ability and potential safety of intravascular FNA to detect radiographically occult RMT, which substantially impacts cancer staging and resectability.
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Affiliation(s)
- Tarun Rustagi
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ferga C Gleeson
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Suresh T Chari
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Prasad G Iyer
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Randall K Pearson
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bret T Petersen
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Rajan
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D Topazian
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Truty
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Santhi S Vege
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kenneth K Wang
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Levy
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
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Meyers D, Nixon NA, Franko A, Ng D, Tam VC. Tumour thrombus of the inferior vena cava extending into the right atrium in the setting of colon cancer. BMJ Case Rep 2017; 2017:bcr2016218107. [PMID: 28193644 PMCID: PMC5318589 DOI: 10.1136/bcr-2016-218107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 01/05/2023] Open
Abstract
Tumour thrombus is seen in renal cell and hepatocellular carcinoma, but is rarely reported in colorectal cancer. A woman aged 46 years, with metastatic colonic adenocarcinoma, was found to have a large mass in the inferior vena cava (IVC) extending into the right atrium. Although this lesion was initially thought to be bland thrombus, imaging with contrast-enhanced CT scan and contrast-enhanced ultrasound supported the diagnosis of tumour thrombus. Despite the large size of the lesion, the patient was asymptomatic. Her lack of symptoms, and poor overall prognosis from her cancer led to the decision to avoid aggressive surgical or radiological interventions. Several months later, the patient passed away. At autopsy, there was no evidence of fatal embolisation from the pre-existing thrombus. Diagnosis of tumour thrombus in the IVC is difficult and management can be challenging due to the significant risks associated with treatment options.
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Affiliation(s)
| | | | | | - Danny Ng
- Foothills Medical Centre, Calgary, Alberta, Canada
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Manik G, Jose J, Hygriv Rao B. Follicular thyroid carcinoma with tumour thrombus extending into superior vena cava and right atrium - A case report. Indian Heart J 2016; 68 Suppl 2:S146-S147. [PMID: 27751268 PMCID: PMC5067792 DOI: 10.1016/j.ihj.2016.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/01/2016] [Accepted: 05/31/2016] [Indexed: 12/30/2022] Open
Abstract
Intra-cardiac extension of tumour thrombus of follicular carcinoma of thyroid is uncommon. We report a case of advanced thyroid carcinoma where tumour thrombus was well profiled with CT scan and transesophageal echo images and extension was noted from SVC into right atrium, with clinical features of superior vena cava syndrome. The clinical significance of the "ring sign" is discussed.
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Affiliation(s)
- Geetesh Manik
- Krishna Institute of Medical Sciences, Hyderabad, India.
| | - John Jose
- Christian Medical College, Vellore, India
| | - B Hygriv Rao
- Division of Pacing & Electrophysiology, Krishna Institute of Medical Sciences, Hyderabad, India
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Abstract
We present a case of pelvic osteosarcoma in an 18-year-old woman with a tumor thrombus in the left iliac vein, extending to the inferior vena cava. Tumor thrombus has been rarely described with osteosarcoma, with only 14 cases in the literature.
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Sonavane SN, Malhotra G, Asopa R, Upadhye T. Role of fluorine-18 fluorodeoxyglucose positron emission tomography in a case of renal cell carcinoma to differentiate tumor thrombus from bland thrombus. Indian J Nucl Med 2015; 30:355-7. [PMID: 26430326 PMCID: PMC4579627 DOI: 10.4103/0972-3919.164016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tumor thrombus is a rare complication of many solid tumors. We present a case of renal cell carcinoma whose baseline contrast-enhanced computerized tomography (CT) revealed an heterogeneously enhancing mass in the upper half of right kidney with tumor thrombus in the right renal vein extending to suprarenal inferior vena cava (IVC), crossing the cavoatrial junction and reaching up to the right atrium (Grade IV). Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT imaging revealed large irregular right renal mass, hypermetabolic tumor thrombus extending from the right renal vein to suprarenal IVC reaching up to the right atrium. There was no FDG uptake noted in the infrarenal IVC and bilateral iliofemoral venous thrombi. Thus, 18F-FDG PET/CT was not only helpful in the staging, but was also helpful in differentiating tumor thrombus from bland thrombus in our patient.
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Affiliation(s)
- Sunita Nitin Sonavane
- Department of Nuclear Medicine and PET/CT, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine and PET/CT, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
| | - Ramesh Asopa
- Department of Nuclear Medicine, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
| | - Trupti Upadhye
- Department of Nuclear Medicine, Radiation Medicine Center, Parel, Mumbai, Maharashtra, India
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Abstract
PURPOSE Thrombosis in cancer may manifest itself as venous thromboembolic disease or tumor thrombosis (TT). We present our experience with incidentally detected TT on FDG PET/CT in 21 oncologic patients. PATIENTS AND METHODS We retrospectively reviewed all FDG PET/CT examinations during a 5-year period at the Army Hospital Research and Referral in New Delhi, India, and included all oncology cases with FDG-avid thrombosis in the report. The diagnosis of TT was based on FDG-avid solid masses inside the vessels in patients with known malignancy. The SUVmax was calculated. RESULTS Twenty-one patients were included; the most common malignancies were renal cell carcinoma (n=6), hepatocellular carcinoma (n=3), and lung cancer (n=3). Indication for the scan was initial staging (n=15) and suspected recurrence (n=6). Several vessels were affected, the most common was the inferior vena cava (n=14), but most other major branches of the venous vasculature was represented, and some patients had thrombi in several vessels. FDG uptake was linear in 7 patients, linear with a dilated vessel in 6 patients, and focal in 7 patients. The mean SUVmax of the primary tumors was 10.3 (range, 2.6-31.2; median, 6.9), and the mean SUVmax of the thrombi was 7.85 (range, 1.7-23.2; median, 6.1). All but 2 patients had additional FDG-avid foci besides the thrombus. CONCLUSIONS This study supports results from other smaller studies regarding the usefulness of FDG PET/CT in TT and corroborates the hypothesis that the SUVmax and the patterns of FDG uptake can be helpful for differentiating BT from TT in oncological patients.
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23
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Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hu S, Zhang J, Cheng C, Liu Q, Sun G, Zuo C. The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis. ACTA ACUST UNITED AC 2015; 39:1221-7. [PMID: 24913670 DOI: 10.1007/s00261-014-0170-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS In this retrospective study, we evaluated the role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in differentiating malignant from benign portal vein thrombosis (PVT) in patients with known malignant tumors. METHODS Seventy-two patients with histologically or clinically confirmed PVT and who had undergone (18)F-FDG PET/CT were included. Visual and semiquantitative analyses of PET/CT scans were performed. Metabolic activity was measured using the maximum standardized uptake value (SUVmax) by drawing the region of interest at the site of thrombosis. Receiver operating characteristic analysis was conducted to identify the optimal cutoff of SUVmax for detecting neoplastic thrombosis. Malignancy was defined using the following criteria: (1) visual analysis and (2) SUVmax >3.35. PET/CT results were confirmed with histopathological results and clinical and imaging follow-up. RESULTS The SUVmax of tumor thrombus (6.37 ± 2.67) was significantly higher than that of bland thrombus (2.87 ± 1.47; P < 0.01). The sensitivities, specificities, and accuracies for the two criteria were 91.5 % and 93.6; 64.0 and 80.0 %; and 81.9 % and 88.9 %, respectively. CONCLUSION (18)F-FDG PET/CT is a promising new method for distinguishing between portal venous neoplastic thrombosis and bland thrombosis using semiquantitative analysis, with the optimal cutoff value of SUVmax >3.35 as a criterion.
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Affiliation(s)
- Shengping Hu
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China,
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25
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Erhamamci S, Reyhan M, Nursal GN, Torun N, Yapar AF. Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2015; 34:287-94. [PMID: 26025479 DOI: 10.1016/j.remn.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. MATERIALS AND METHODS Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). RESULTS The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. CONCLUSION Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients.
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Affiliation(s)
- S Erhamamci
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey.
| | - M Reyhan
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| | - G N Nursal
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| | - N Torun
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| | - A F Yapar
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
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Rohatgi S, Howard SA, Tirumani SH, Ramaiya NH, Krajewski KM. Multimodality Imaging of Tumour Thrombus. Can Assoc Radiol J 2015; 66:121-9. [DOI: 10.1016/j.carj.2014.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/12/2014] [Indexed: 12/29/2022] Open
Abstract
Vascular thrombosis occurs commonly in cancer patients. Once the diagnosis of thrombosis is established, it is important to characterize the nature of thrombus, tumoural versus bland, as each have a different prognosis, clinical significance, and management. This review paper discusses the imaging spectrum of tumour thrombus and its clinical significance emphasizing the role of imaging in differentiating tumour from bland thrombus.
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Affiliation(s)
- Saurabh Rohatgi
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie A. Howard
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nikhil H. Ramaiya
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine M. Krajewski
- Department of Imaging, Dana Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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27
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Unusual presentation of testicular cancer with tumor thrombus extending to the inferior vena cava. Case Rep Urol 2015; 2015:160560. [PMID: 26000192 PMCID: PMC4426900 DOI: 10.1155/2015/160560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
A 45-year-old man with a left testis tumor with a 25 mm para-aortic lymph node swelling, multiple bilateral pulmonary metastases, bilateral pulmonary embolism, and inferior vena cava (IVC) thrombus underwent a radical orchidectomy in our institution. The thrombus extended from the left gonadal vein to the left renal vein to the IVC. The fluorine-18 fluorodeoxyglucose (f-FDG) positron emission tomography (PET) computerized tomography (CT) demonstrated a hypermetabolic focus in the retroperitoneum and in the IVC thrombus. Before orchidectomy only lactate dehydrogenase (LDH) was high but all the serum tumor markers increased postoperatively. The tumor was staged pT1N2M1aS1, which was an intermediate prognosis, based on the International Germ Cell Cancer Collaborative Group consensus (IGCCCG). After 4 courses of bleomycin, etoposide, and cisplatin (BEP) chemotherapy the patient's tumor markers normalized and the thrombus disappeared. There was only one residual retroperitoneal lymph node M1. Retroperitoneal lymph node dissection was performed. The pathological examination revealed only necrotic tissues. The patient has been disease-free since surgery.
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28
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Tumor Thrombus as a Rare Presentation of Lymphoma: A Case Series of 14 Patients. AJR Am J Roentgenol 2015; 204:W398-404. [DOI: 10.2214/ajr.14.12782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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29
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Karanth SS, Vaid AK, Batra S, Sharma D. Mediastinal germ cell tumour causing superior vena cava tumour thrombosis. BMJ Case Rep 2015; 2015:bcr-2014-208356. [PMID: 25809431 DOI: 10.1136/bcr-2014-208356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a rare case of a 35-year-old man who presented with a 1-week history of retrosternal chest pain of moderate intensity. A positron emission tomography CT (PET-CT) showed a large fluorodeoxy-glucose (FDG)-avid heterogeneously enhancing necrotic mass in the anterosuperior mediastinum with a focal FDG-avid thrombosis of the superior vena cava (SVC) suggestive of tumour thrombus and vascular invasion. α-Fetoprotein levels were raised (5690 IU/L). Image guided biopsy of the mediastinal mass was suggestive of non-seminomatous germ cell tumour (NSGCT). The patient received four cycles of BEP (bleomycin, etoposide and cisplatin) along with therapeutic anticoagulation with low-molecular-weight heparin. Follow-up whole body PET-CT revealed complete resolution of mediastinal mass and SVC tumour thrombosis. The documentation of FDG-PET-avid tumour thrombus resolving with chemotherapy supports the concept of circulating tumour cells being important not only in common solid tumours such as breast and colon cancer but also in relatively less common tumours such as NSGCT. The detection of circulating tumour cells could help deploy aggressive regimens upfront.
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Affiliation(s)
- Suman S Karanth
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Ashok K Vaid
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Sandeep Batra
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Devender Sharma
- Department of Medical Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
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30
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Jeph S, Thakur K, Shamim S, Verma K, Aggarwal B, Aggarwal A. Giant cardiac tumour thrombus on staging contrast enhanced 18F-FDG PET/CT in a case of non-Hodgkin's lymphoma. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Preoperative FDG PET/CT in Adrenocortical Cancer Depicts Massive Venous Tumor Invasion. Clin Nucl Med 2014; 39:570-2. [DOI: 10.1097/rlu.0000000000000414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Filippi L, Sardella B, Ciorra A, Scopinaro F, Bagni O. Tumor thrombus in the renal vein from an adrenal metastasis of lung cancer: 18FDG PET/CT findings. Cancer Biother Radiopharm 2014; 29:189-92. [PMID: 24852381 DOI: 10.1089/cbr.2014.1612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tumor thrombus is a rare complication of solid cancer. The authors report a case of a 76-year-old woman presenting a thick walled cystic mass in the lower lobe of the left lung. 18FDG positron emission tomography (PET)/computed tomography (CT) was performed, showing tracer accumulation in the wall of the pulmonary lesion and in the mediastinal and hilar lymph nodes. Moreover, PET/CT depicted a gross mass in the left adrenal gland and a hypermetabolic focus corresponding to the anatomic location of the left renal vein. Contrast-enhanced CT, subsequently performed, confirmed PET findings in the lung, lymph nodes, and adrenal glands, also demonstrating marginal enhancement and intraluminal filling defect in the left renal vein, which was interpreted as tumor thrombus due to the 18FDG uptake at PET scan. CT-guided biopsy of the mass was positive for poorly differentiated carcinoma. 18FDG PET can be useful to diagnose tumor thrombus in oncological patients.
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Affiliation(s)
- Luca Filippi
- 1 Section of Nuclear Medicine, Santa Maria Goretti Hospital , Latina, Italy
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33
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Giant cardiac tumour thrombus on staging contrast enhanced ¹⁸F-FDG PET/CT in a case of non-Hodgkin's lymphoma. Rev Esp Med Nucl Imagen Mol 2014; 33:328-9. [PMID: 24618093 DOI: 10.1016/j.remn.2013.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/21/2022]
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34
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Takai T, Murata Y. Case of tumor thrombus inside femoral vein, formed by melanoma metastasized to inguinal lymph node. J Dermatol 2014; 41:427-9. [DOI: 10.1111/1346-8138.12444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Toshihiro Takai
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
| | - Yozo Murata
- Department of Dermatology; Hyogo Cancer Center; Akashi Japan
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35
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Liu Y. Migrating tumor thrombus trapped within the greenfield filter of the inferior vena cava and depicted by FDG PET/CT. Clin Nucl Med 2013; 39:214-6. [PMID: 24300365 DOI: 10.1097/rlu.0000000000000318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 72-year-old woman with leiomyosarcoma of the left thigh underwent a whole-body FDG PET/CT for staging, which demonstrated a large FDG-avid tumor in the left thigh and tumor thrombosis involving the profunda femoris artery/vein and superior femoral vein. A Greenfield filter was placed in the inferior vena cava before the radical resection of the tumor and thrombosis. Postoperative PET/CT showed an FDG-avid embolus trapped within the solid apical cap of the filter in the inferior vena cava. It was unknown if the tumor embolus migrated to the inferior vena cava before or during the surgical procedure of radical resection.
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Affiliation(s)
- Yiyan Liu
- From the Nuclear Medicine Service, Department of Radiology, Rutgers University-New Jersey Medical School, NJ
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36
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Intravenous tumour thrombus from papillary carcinoma of thyroid- a case report & review of literature. Indian J Surg Oncol 2013; 3:206-7. [PMID: 23997507 DOI: 10.1007/s13193-012-0126-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 01/30/2012] [Indexed: 12/14/2022] Open
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38
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Tumor thrombosis detected on PET/CT scanning in a patient with metastasic melanoma. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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39
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40
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Conejero A, Vidal-Sicart S, Navales I, Pons F. Tumor thrombosis detected on PET/CT scanning in a patient with metastasic melanoma. Rev Esp Med Nucl Imagen Mol 2012; 32:115-6. [PMID: 23137813 DOI: 10.1016/j.remn.2012.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 11/28/2022]
Affiliation(s)
- A Conejero
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.
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41
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Mudalsha R, Jacob M, Pandit A, Jora C. Extensive tumor thrombus in a case of carcinoma lung detected by F18-FDG-PET/CT. Indian J Nucl Med 2012; 26:117-9. [PMID: 22174524 PMCID: PMC3237216 DOI: 10.4103/0972-3919.90269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tumor thrombus is a rare complication of solid cancers, mainly seen in cases of renal cell carcinoma, wilm's tumor, testicular carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma.[1] Tumor thrombus in inferior vena cava is a rare complication of primary carcinoma lung. It should be identified so as to rule out venous thromboembolism and avoiding unnecessary anticoagulant therapy. We describe a case where F18-Fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET/CT) helped to identify extensive tumor thrombus.
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Affiliation(s)
- Ravina Mudalsha
- Department of Nuclear Medicine, Army Hospital, Research and Referral, Delhi Cantt, New Delhi, India
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Lee EJ, Moon SH, Choi JY, Lee KS, Choi YS, Choe YS, Lee KH, Kim BT. Usefulness of fluorodeoxyglucose positron emission tomography in malignancy of pulmonary artery mimicking pulmonary embolism. ANZ J Surg 2012; 83:342-7. [DOI: 10.1111/j.1445-2197.2012.06205.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Eun Jeong Lee
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Joon Young Choi
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Kyung Soo Lee
- Department of Radiology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Yearn Seong Choe
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul; Korea
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Coccia P, Ruggiero A, Rufini V, Maurizi P, Attinà G, Marano R, Natale L, Leccisotti L, Calcagni ML, Riccardi R. Cardiac metastases of Ewing sarcoma detected by 18F-FDG PET/CT. J Pediatr Hematol Oncol 2012; 34:236-238. [PMID: 22395217 DOI: 10.1097/mph.0b013e318242754d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Positron emission tomography (PET) is widely used in the diagnostic evaluation and staging of different malignant tumors. The role of PET/computed tomographic scan in detecting distant metastases in the workup of Ewing sarcoma in children or young adults is less well defined. We report a case of a boy affected by a metastatic Ewing sarcoma with cardiac asymptomatic metastasis detected by F-FDG PET/computed tomography.
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Affiliation(s)
- Paola Coccia
- Division of Paediatric Oncology, Catholic University of Rome, Italy.
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Abstract
The incidence of early and advanced-stage renal cell carcinoma (RCC) is increasing. Methods of diagnosing, staging and evaluating tumor burden that are more accurate and reliable than the currently available options are needed in order to identify RCC at a stage at which it is curable and to accurately determine the response to treatment. Functional imaging, particularly with combined PET-CT, might improve accuracy of detection and provide essential information that has been unavailable to date. This approach is against a background in which targeted therapies for metastatic RCC have entered clinical practice in the past few years, further highlighting the importance of accurate imaging for patient selection and for monitoring response to treatment. We outline the current clinical status of functional imaging in RCC using PET-CT, which allows simultaneous capture and co-registration of functional and anatomical data. New radiotracers and approaches-including radiolabeled monoclonal antibodies and imaging of tumor hypoxia-are touched on, and areas of future research discussed.
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Metastatic choriocarcinoma with tumor thrombus in the right atrium and pulmonary vessels: diagnosis and therapy monitoring with F-18 flurodeoxyglucose PET/CT. Clin Nucl Med 2009; 34:381-5. [PMID: 19487853 DOI: 10.1097/rlu.0b013e3181a3461f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in a case of choriocarcinoma presenting as pulmonary embolism. Clin Nucl Med 2009; 34:343-5. [PMID: 19487841 DOI: 10.1097/rlu.0b013e3181a34634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case demonstrates the utility of performing F-18 fluorodeoxyglucose positron emission tomography/computed tomography for the investigation of an unresolving pulmonary embolus, where early diagnosis of tumor thrombus or primary neoplastic conditions of the pulmonary artery may be made. Choriocarcinoma presenting within the pulmonary artery is rare although a literature review shows that a number of important differential diagnoses of hypermetabolic pulmonary lesions should be kept in mind.
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Renal vein lymphoma embolism in non-Hodgkin lymphoma. Int J Hematol 2008; 88:613-615. [PMID: 19039628 DOI: 10.1007/s12185-008-0213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 10/23/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022]
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Quirce Pisano R, Banzo Marraco I, Jiménez-Bonilla JF, Martínez-Rodríguez I, Sainz Esteban A, Carril Carril JM. [Potential sources of diagnostic pitfall and variants in FDG-PET/CT]. ACTA ACUST UNITED AC 2008; 27:130-59. [PMID: 18367053 DOI: 10.1157/13117196] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Oncological FDG PET show variants and findings that may lead to a diagnostic error and that may be clarified by the morfofunctional imaging from PET/CT. In this article we show the experience acquired since a Siemens PET/CT Biograph LSO Pico3D was applied in our centre. We describe some representative examples of FDG distribution patterns which may lead to erroneous interpretations of the clinical studies when they refer to specific clinical situations. The examples included are classified into two main groups according to the cause: Technical and biological, and the latter into physiological and non-physiological (pathophysiological). Patterns are described within the biological group showing changes of the FDG biodistribution that may reduce the uptake in tumoural lesions, the physiological variants that may be interpreted as pathology, the effects of previous treatment and uptakes related to benign diseases. CONCLUSION We consider that knowledge of these variants and findings to be crucial in order to obtain optimal performance of PET/CT and to overcome the PET limitations.
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Affiliation(s)
- R Quirce Pisano
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España.
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