Case of the Month—June 2003

Lung Cancer/Response to Therapy

History
A 41-year-old male with a history of heavy smoking and work-related exposure to fumes presented with hemoptysis.

Initial Findings
A CT of the thorax showed a large spiculated mass measuring 4 cm in the right upper lobe.

The pathology report identified a non-small cell bronchogenic carcinoma, invasive, poorly differentiated.

PET Findings—Staging Study 7/16/02
The whole-body FDG PET scan revealed a large multilobulated focus of hypermetabolism in the right upper lobe extending to the chest wall and hilar region. Focal areas of uptake also seen in the right hilum, right paratracheal area, AP window region, and prevascular area. Focal intense uptake in both adrenal glands is also seen, consistent with metastatic disease, stage IV.

PET Findings—Restaging Study 12/03/02
After several courses of chemo- therapy, the whole-body FDG PET study revealed markedly reduced uptake in all areas, indicating excellent response to therapy.


Staging PET Scan 7/16/02. Coronal section demonstrates focal areas of increased uptake consistent with tumor. Arrows indicate bilateral adrenal uptake.	Re-staging PET scan 12/3/02. Coronal section shows significanly reduced uptake sonsistent with therapy response. Note complete resolution of adrenal uptake.

How Did PET Help?
The initial PET study provided accurate staging of the lung cancer. The follow-up restaging PET study demonstrated a positive response to therapy, including complete resolution of adrenal uptake.

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