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Solitary spinal epidural metastasis from lung carcinoma.

Gupta M, Choudhary P, Jain A, Pruthi A - Indian J Nucl Med (2014)

Bottom Line: Epidural involvement in the spine is mostly sequelae of direct infiltration from bony involvement.Direct hematogenous spread to epidural space is very rare.Early diagnosis and treatment before the development of permanent neurologic and functional deficits is essential for a favorable prognosis in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.

ABSTRACT
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) has revealed many unusual presentations and early detection of metastasis in many carcinomas. Epidural involvement in the spine is mostly sequelae of direct infiltration from bony involvement. Direct hematogenous spread to epidural space is very rare. Early diagnosis and treatment before the development of permanent neurologic and functional deficits is essential for a favorable prognosis in such cases. We report here a case of solitary spinal epidural metastasis from lung cancer which was the only systemic metastasis detected on F-18 FDG PET/CT and later confirmed by clinical and regional magnetic resonance imaging findings. This report is, to the best of our knowledge, the first description of such a presentation of systemic metastasis from lung cancer on F-18 FDG PET/CT.

No MeSH data available.


Related in: MedlinePlus

Axial FDG PET CT fused and CT images shows metabolically active lesion in right neural foramina region
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Figure 1: Axial FDG PET CT fused and CT images shows metabolically active lesion in right neural foramina region

Mentions: A 78-year-old Indian lady was investigated for cough and weight loss. Initial baseline investigations suggested adenocarcinoma of right lung. Whole body F-18 FDG PET/CT was done for staging workup. The PET/CT scan showed right lung middle lobe mass with few ipsilateral mediastinal lymphnodes. An unusual tracer uptake in D12-L1 right neural foramina region was also noted [Figure 1]. On questioning, she reported lower backache and right hip region pain which was till that time being attributed to old age and degenerative changes. Due to persistent backache, regional MRI was advised after 15 days of PET/CT, which revealed enhancing focal epidural soft tissue thickening on right side at D12-L1 level [Figure 2]. Image-guided biopsy was not amenable and open biopsy was not performed in her clinical context. In view of clinical symptomatology and dual imaging findings, a diagnosis of solitary epidural metastasis was considered. Patient was given for D11-L2 radiotherapy which relieved her symptoms subsequently.


Solitary spinal epidural metastasis from lung carcinoma.

Gupta M, Choudhary P, Jain A, Pruthi A - Indian J Nucl Med (2014)

Axial FDG PET CT fused and CT images shows metabolically active lesion in right neural foramina region
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928750&req=5

Figure 1: Axial FDG PET CT fused and CT images shows metabolically active lesion in right neural foramina region
Mentions: A 78-year-old Indian lady was investigated for cough and weight loss. Initial baseline investigations suggested adenocarcinoma of right lung. Whole body F-18 FDG PET/CT was done for staging workup. The PET/CT scan showed right lung middle lobe mass with few ipsilateral mediastinal lymphnodes. An unusual tracer uptake in D12-L1 right neural foramina region was also noted [Figure 1]. On questioning, she reported lower backache and right hip region pain which was till that time being attributed to old age and degenerative changes. Due to persistent backache, regional MRI was advised after 15 days of PET/CT, which revealed enhancing focal epidural soft tissue thickening on right side at D12-L1 level [Figure 2]. Image-guided biopsy was not amenable and open biopsy was not performed in her clinical context. In view of clinical symptomatology and dual imaging findings, a diagnosis of solitary epidural metastasis was considered. Patient was given for D11-L2 radiotherapy which relieved her symptoms subsequently.

Bottom Line: Epidural involvement in the spine is mostly sequelae of direct infiltration from bony involvement.Direct hematogenous spread to epidural space is very rare.Early diagnosis and treatment before the development of permanent neurologic and functional deficits is essential for a favorable prognosis in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India.

ABSTRACT
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) has revealed many unusual presentations and early detection of metastasis in many carcinomas. Epidural involvement in the spine is mostly sequelae of direct infiltration from bony involvement. Direct hematogenous spread to epidural space is very rare. Early diagnosis and treatment before the development of permanent neurologic and functional deficits is essential for a favorable prognosis in such cases. We report here a case of solitary spinal epidural metastasis from lung cancer which was the only systemic metastasis detected on F-18 FDG PET/CT and later confirmed by clinical and regional magnetic resonance imaging findings. This report is, to the best of our knowledge, the first description of such a presentation of systemic metastasis from lung cancer on F-18 FDG PET/CT.

No MeSH data available.


Related in: MedlinePlus