Case of the Month—May 2004

Laryngeal Carcinoma—Incidental Finding of Liver Cancer

History
The patient in this case is a 74-year old male with a known history of laryngeal carcinoma. In early December 2003, the patient underwent a staging CT of the neck which indicated a mass along the right vocal cord consistent with the known laryngeal tumor. The CT also noted slightly enlarged lymph nodes along the right side of the neck.

PET Findings
A follow-up PET study was ordered in late December 2003. This scan showed a large area of intense increased FDG accumulation within the anterior aspect of the neck in the midline representing the known primary laryngeal carcinoma. Two hypermetabolic foci were also noted on the right side of the neck consistent with metastatic lymph nodes. An area of mild FDG uptake was noted in the posterior aspect of the right chest wall which is likely related to recent trauma.

The whole-body PET scan also showed an increased area of mild uptake in the inferior aspect of the right lobe of the liver (Figure 1). The PET report suggested CT follow-up of this finding in the liver.

Figure 1

Follow-Up
A CT scan of the abdomen and pelvis with contrast was performed in early January 2004 as a follow-up to patient PET scan of December 29, 2003. The liver demonstrates an area of low attenuation in inferior segment (Figure 2) that corresponds to the area of increased uptake on the PET scan. Mildly heterogeneous in nature and approximately 6 cm in size, this most likely represents neoplasm. The pancreas, spleen, and kidneys were unremarkable. A biopsy of the liver was conducted in late January 2004, with the pathology report confirming a hepatocellular carcinoma.

Figure 2

How Did PET help?
The PET study confirmed primary laryngeal cancer and identified metastatic lymph nodes in the right side of the neck. Moreover, the PET also identified a previously unknown second primary cancer within the liver.

Discussion
PET can be of great value in imaging head and neck cancer, which has a growing incidence and now accounts for up to 5% of all cancers diagnosed (1). PET is often used to assess response to therapy and to check for recurrence of disease. As a whole-body study, it is also a useful tool in identifying distant metastasis and additional undetected primary cancers (2).

(1) Greenlee, R.T., Muray, T., and Wingo, P.A. “Cancer Statistics 2000,” CA-A Cancer J Clin. 200; 50:7-33.
(2) Braams, et al, “Detection of Unknown Primary Head and Neck Tumors by PET,” Int J Oral Maxillofacial Surg 1997; 26 (2):112-115.

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