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HEAD AND NECK

HISTORY

60-year-old male with a history of squamous cell carcinoma of the right posterior oropharynx and right neck who underwent a right modified neck dissection and radiation therapy in 1996 and presents with new onset left-sided throat pain. Physical exam was unrevealing.

PET/CT FINDINGS

Focal area of intense FDG uptake in the left retromolar trigone area obscured on the CT portion of the exam by artifact from metallic dental implants depicted above (arrows). Also, focal intense FDG uptake in the right lung apex corresponding to the area of “scarring” identified on the patient’s recent CT scan (arrows) depicted below.

PATHOLOGY

Oropharynx, left retromolar trigone, biopsy invasive squamous cell carcinoma, well to moderately differentiated. Right apical lung mass, poorly differentiated adenocarcinoma, 2.3cm with invasion of visceral pleura.

TREATMENT / FOLLOW UP

Resection of left retromolar trigone and right apical mass.

DISCUSSION

This patient was referred to the PET center to evaluate the status of this patient’s head and neck malignancy. He initially had a right-sided oropharyngeal tumor which was resected. He had some additional radiation therapy and had a good response to therapy. He did well for over a year, at which time he developed pain on the opposite side. Physical exam was unrevealing. Incidentally, the patient had a CT of the neck and chest prior to coming for his PET/CT which was completely negative except some scarring at the lung apices, which was thought to be due to prior radiation.

His PET/CT revealed not only where the primary tumor was, but also that he had evidence for a second primary malignancy in his right lung apex. This case demonstrates two advantages of combined PET/CT. The first is the ability to detect precisely where an area of recurrence is, even when there is obscuration by CT artifact, as in this case. The second is the ability to survey the entire body and have the potential of detecting small metastatic lesions or, as in this case, an early second lung primary adenocarcinoma.

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