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18F-FDG PET/CT in initial staging and treatment response evaluation in a patient with thymoma
PET/TC con 18F-FDG en la estadificación inicial y evaluación de respuesta al tratamiento en un paciente con timoma
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Se observa una lesión nodular de bordes mal definidos, con bajo coeficiente de atenuación, localizada en pared torácica lateral derecha, entre el quinto y sexto arco costal derecho, por debajo de la musculatura oblicua, que presenta un marcado aumento del metabolismo glucídico (SUV máx. 16), sin otros hallazgos relevantes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.M. Hernández Heredia, A. Seva Delgado, R.J. Ávila Martínez, P.C. Gálvez Diez, L.F. Villares" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C.M." "apellidos" => "Hernández Heredia" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Seva Delgado" ] 2 => array:2 [ "nombre" => "R.J." "apellidos" => "Ávila Martínez" ] 3 => array:2 [ "nombre" => "P.C." "apellidos" => "Gálvez Diez" ] 4 => array:2 [ "nombre" => "L.F." "apellidos" => "Villares" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808917300642" "doi" => "10.1016/j.remnie.2017.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808917300642?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X16302098?idApp=UINPBA00004N" "url" => "/2253654X/0000003600000005/v1_201708180047/S2253654X16302098/v1_201708180047/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET/CT in initial staging and treatment response evaluation in a patient with thymoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "339" "paginaFinal" => "340" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Uslu-Beşli, Y. Akın, T.F. Çermik" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Uslu-Beşli" "email" => array:1 [ 0 => "lebriz@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Y." "apellidos" => "Akın" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "T.F." "apellidos" => "Çermik" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Istanbul Training and Research Hospital, Nuclear Medicine Clinic, Istanbul, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sakarya University, Faculty of Medicine, Department of Nuclear Medicine, Sakarya, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "PET/TC con <span class="elsevierStyleSup">18</span>F-FDG en la estadificación inicial y evaluación de respuesta al tratamiento en un paciente con timoma" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 381 "Ancho" => 2001 "Tamanyo" => 72608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Post-treatment fused FDG PET/CT images show complete resolution of anterior mediastinal mass and accompanying mediastinal lymph nodes, also complete regression in the right pleural uptake (A–C). Only minimally increased linear FDG uptake around the mediastinal mesh material was detected, which was consistent with postoperative inflammatory response. MIP image supports complete regression of mediastinal mass and lymph nodes (D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 47-year old male patient was admitted to our hospital for complaints about generalized body pain, shortness of breath and jaundice. He had elevated levels of total and direct bilirubin, in addition to elevated liver enzymes and hypoalbuminemia. Thoracic CT scan showed anterior mediastinal soft tissue mass accompanied with enlarged mediastinal lymph nodes, therefore <span class="elsevierStyleSup">18</span>F-FDG PET/CT scan was performed, which revealed increased FDG uptake in 8.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5.5<span class="elsevierStyleHsp" style=""></span>cm sized anterior mediastinal mass extending to right paracardiac space (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Right axillary lymph node with increased <span class="elsevierStyleSup">18</span>F-FDG uptake was also present (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Moreover, enlarged left prevascular and retrosternal lymph nodes with increased <span class="elsevierStyleSup">18</span>F-FDG uptake were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). The patient also had prominent nodular pleural thickening in the right hemithorax with increased <span class="elsevierStyleSup">18</span>F-FDG uptake accompanied with pleural effusion with minimally increased <span class="elsevierStyleSup">18</span>F-FDG uptake (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Additional superior and inferior mesenteric, aortocaval and bilateral inguinal lymph nodes exhibiting increased <span class="elsevierStyleSup">18</span>F-FDG uptake were also present (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Thymic carcinoma or aggressive thymomas and lymphomas were included in the differential diagnosis and the biopsy taken from the mediastinal mass resulted in lymphocyte rich thymoma (WHO type B2).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Direct hyperbilirubinemia and related jaundice was found to be related to autoimmune cholangitis, which is one of the autoimmune syndromes associated with thymoma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Neoadjuvant chemotherapy followed by complete surgical resection including wedge resection of right lower and middle lung lobes and partial pericardiectomy were performed. Post-treatment <span class="elsevierStyleSup">18</span>F-FDG PET/CT scan showed complete resolution of anterior mediastinal mass, as well as the mediastinal, axillary and abdominopelvic lymph nodes and complete regression in the right pleural uptake (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Only minimally increased linear FDG uptake around the mediastinal mesh material was detected, which was consistent with postoperative inflammatory response.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Thymic epithelial tumors, including thymomas and thymic carcinomas, represent the most common tumor of the anterior mediastinum. <span class="elsevierStyleSup">18</span>F-FDG PET/CT can be useful not only in predicting the grade of the thymic epithelial tumors, but also in the initial staging and therapy response assessment of thymic epithelial tumors.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">All authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 527 "Ancho" => 1800 "Tamanyo" => 89568 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET (A), CT (B) and fused PET/CT (C) images reveal increased FDG uptake in the anterior mediastinal mass extending to right paracardiac space (SUVmax: 8.9). Right axillary lymph node with increased FDG uptake is also visualized (arrows).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 377 "Ancho" => 2000 "Tamanyo" => 86565 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fused FDG PET/CT images show enlarged left prevascular and retrosternal lymph nodes (A), pleural thickening in the right hemithorax (B) and abdominal lymph nodes (C) with increased FDG uptake. Mediastinal mass and supra- and infradiaphragmatic lymph nodes can be seen in the MIP image with increased FDG uptake (D).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 381 "Ancho" => 2001 "Tamanyo" => 72608 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Post-treatment fused FDG PET/CT images show complete resolution of anterior mediastinal mass and accompanying mediastinal lymph nodes, also complete regression in the right pleural uptake (A–C). Only minimally increased linear FDG uptake around the mediastinal mesh material was detected, which was consistent with postoperative inflammatory response. MIP image supports complete regression of mediastinal mass and lymph nodes (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is <span class="elsevierStyleSup">18</span>F-FDG PET useful in predicting the WHO grade of malignancy in thymic epithelial tumors? A meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Treglia" 1 => "R. Sadeghi" 2 => "L. Giovanella" 3 => "S. Cafarotti" 4 => "P. Filosso" 5 => "F. Lococo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.lungcan.2014.08.008" "Revista" => array:6 [ "tituloSerie" => "Lung Cancer" "fecha" => "2014" "volumen" => "86" "paginaInicial" => "5" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25175317" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thymoma and thymic carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Scorsetti" 1 => "F. Leo" 2 => "A. Trama" 3 => "R. D’Angelillo" 4 => "D. Serpico" 5 => "M. Macerelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Crit Rev Oncol Hematol" "fecha" => "2016" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-FDG uptake on PET helps predict outcome and response after treatment in unresectable thymic epithelial tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Kaira" 1 => "H. Murakami" 2 => "S. Miura" 3 => "R. Kaira" 4 => "H. Akamatsu" 5 => "M. Kimura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12149-010-0455-x" "Revista" => array:6 [ "tituloSerie" => "Ann Nucl Med" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "247" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21174178" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2253654X/0000003600000005/v1_201708180047/S2253654X16300804/v1_201708180047/en/main.assets" "Apartado" => array:4 [ "identificador" => "67841" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes de interes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000003600000005/v1_201708180047/S2253654X16300804/v1_201708180047/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X16300804?idApp=UINPBA00004N" ]
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