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Early recurrence detected by [18F]FDG PET/CT and fibrobroncoscopy findings in a patient with multiple tracheal metastasis of endometrial carcinoma
Recidiva precoz detectada por [18F]FDG PET/TC y hallazgos en la fibrobroncoscopia en paciente con metástasis traqueal múltiple de carcinoma de endometrio
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A pocos centímetros de la lesión principal se localizaron 2 pólipos más (1B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Fernández-Rodríguez, Y. Herrera-Martínez, C. Sánchez Matas, I. Acevedo Báñez, J.M. Jiménez-Hoyuela García" "autores" => array:5 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Fernández-Rodríguez" ] 1 => array:2 [ "nombre" => "Y." "apellidos" => "Herrera-Martínez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Sánchez Matas" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Acevedo Báñez" ] 4 => array:2 [ "nombre" => "J.M." 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B, coronal fused PET/CT image; C, sagittal fused PET/CT image; D, axial PET images, E, axial CT images; F, axial fused PET/CT images).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuh Filizoglu, Salih Ozguven" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Nuh" "apellidos" => "Filizoglu" ] 1 => array:2 [ "nombre" => "Salih" "apellidos" => "Ozguven" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X21000974" "doi" => "10.1016/j.remn.2021.03.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X21000974?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921001099?idApp=UINPBA00004N" "url" => "/22538089/0000004100000006/v1_202211060529/S2253808921001099/v1_202211060529/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808921001245" "issn" => "22538089" "doi" => "10.1016/j.remnie.2021.07.003" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "1316" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2022;41:389-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Chemotherapy-induced pericarditis in anaplastic large cell lymphoma patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "389" "paginaFinal" => "390" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pericarditis Inducida por quimioterapia en pacientes conlinfomaanaplásico decélulas grandes" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2006 "Ancho" => 3174 "Tamanyo" => 474389 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretreatment FDG PET/CT showed multiple hypermetabolic lymph nodes in the cervical, axillary, paraaortic, and iliac regions (A; MIP image). No pathological FDG uptake was observed in the pericardium (B; coronal fused PET/CT image, C; sagittal fused PET/CT image). Post-treatment FDG PET/CT demonstrated complete resolution of all hypermetabolic lymph nodes (D; MIP image). FDG PET/CT also showed diffuse FDG uptake along the thickened pericardium (E; coronal fused PET/CT image, F; sagittal fused PET/CT image, G; transaxial PET image, H; transaxial CT image, and I; transaxial fused PET/CT images).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuh Filizoglu, Salih Ozguven, Tunc Ones, Halil Turgut Turoglu, Tanju Yusuf Erdil" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Nuh" "apellidos" => "Filizoglu" ] 1 => array:2 [ "nombre" => "Salih" "apellidos" => "Ozguven" ] 2 => array:2 [ "nombre" => "Tunc" "apellidos" => "Ones" ] 3 => array:2 [ "nombre" => "Halil Turgut" "apellidos" => "Turoglu" ] 4 => array:2 [ "nombre" => "Tanju Yusuf" "apellidos" => "Erdil" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X21001323" "doi" => "10.1016/j.remn.2021.06.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X21001323?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808921001245?idApp=UINPBA00004N" "url" => "/22538089/0000004100000006/v1_202211060529/S2253808921001245/v1_202211060529/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Early recurrence detected by [<span class="elsevierStyleSup">18</span>F]FDG PET/CT and fibrobroncoscopy findings in a patient with multiple tracheal metastasis of endometrial carcinoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "391" "paginaFinal" => "392" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Fernández-Rodríguez, Y. Herrera-Martínez, C. Sánchez Matas, I. Acevedo Báñez, J.M. Jiménez-Hoyuela García" "autores" => array:5 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Fernández-Rodríguez" "email" => array:1 [ 0 => "paulafer.rodri@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" => "Herrera-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Sánchez Matas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "I." "apellidos" => "Acevedo Báñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J.M." "apellidos" => "Jiménez-Hoyuela García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recidiva precoz detectada por [<span class="elsevierStyleSup">18</span>F]FDG PET/TC y hallazgos en la fibrobroncoscopia en paciente con metástasis traqueal múltiple de carcinoma de endometrio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 869 "Ancho" => 1750 "Tamanyo" => 167831 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">[18F]FDG PET/CT showed a marked increase in uptake (SUVmax of 15.8) in the lateral aspect of the lower third of the trachea (2A axial) (2B, coronal, arrow). Mediastinal and hilar lymph nodes with an SUVmax of 11.4 (2D, MIP). Fiberoptic bronchoscopy revealed a flat endotracheal lesion with a large circumferential component (2E). Simple Dumon tracheal stent placement (2F).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a 54-year-old female with medical history of endometrioid adenocarcinoma stage IIIC2 treated in 2017 with hysterectomy, pelvic and para-aortic lymphadenectomy as well as concurrent chemoradiotherapy. The patient remained asymptomatic and presented complete clinical and radiological response. However, two years later, the patient presented an episode of hemoptysis for three days. Due to the history of habitual smoking, a chest CT scan was requested to rule out neoplastic lung pathology as the first option.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The chest CT excluded both lung and bronchopulmonary disease but showed un unspecific intraluminal polypoid lesion up to 10 mm located on the lower third of the trachea, depending on its posterior wall, and causing important stenosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Two more polyps were located a few centimetres from the main lesion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).Tracheal papillomatosis was included in the differential diagnosis. Nevertheless, Human Papillomavirus (HPV) resulted negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A fibrobronchoscopy showed three unspecific pearlescent exophytic endotracheal polyps with an important circunferencial component and significant tracheal lumen reduction, occluding the largest of them 70% of the lumen. These polypoids lesion were completely removed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Immunohistochemical profile was positive to estrogen and progesterone receptors, citokeratin 7 and carcinoembryonic antigen. This technique was negative for Thyroid Transcription Factor-1 (TTF-1, indicator for lung adenocarcinoma), CK20 (colorectal adenocarcinoma), sinaptofisina and cromogranin (neuroendocrine tumors). These results were similar to those of the primary uterine neoplastic lesion. Finally, histopatological results confirmed metastasis of endometrial adenocarcinoma. Subsequently, palliative hormonal treatment with megestrol acetate was indicated.</p><p id="par0025" class="elsevierStylePara elsevierViewall">According to these findings, a [18F] FDG PET/CT was requested for disease staging and showed an intense increase of radiotracer uptake (SUVmax of 15.8) located on the lateral side of the lower third of the tracheal (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A, [18F]FDG PET/TC axial view; <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B, [18F]FDG PET/TC coronal view, arrow). No polypoid lesions and no other anatomical findings were identified (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C, coronal CT view, arrow). This finding was suggestive of an early local recurrence. Moreover, [18F]FDG PET/CT showed several mediastinal and hiliar lymphatic nodes with SUVmax of 11.4, supporting lymphatic metastatic disease (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>D, MIP).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Taking into account these findings, a new fibrobronchoscopy was indicated to assess the existence of disease. A flat endotracheal lesion with a large circumferential component was observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E). Finally, it was removed and a tracheal relapse of endometrial adenocarcinoma was histologically confirmed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the circunferencial growth pattern of the tumor, it was not possible to perform any more endoluminal resections in this patient. Instead, a Dumon simple tracheal endoprotesis was placed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>F) and a second line of palliative treatment was established.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Endometrial carcinoma presents high potential to metastasize and develop recurrences, mostly located in pelvic structures including regional pelvic lymph nodes and para-aortic nodes as the most common site of spread disease. Pulmonary metastasis represent the most common location of extrapelvic spread of disease<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Some cases of endobronchial metastasis have been described in patients with endometrial carcinoma associating hemoptisis episodes<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. However, the trachea should be considered although it is an extremely rare location of extrapelvic spread of disease in these patients<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This case highlights a highly hypermetabolic endotracheal thickening in [18F]FDG PET/CT resulting in an early metastasis recurrence. Therefore, endotracheal metastasis related to several tracheal polyps in a patient with history of endometrial adenocarcinoma who suffer from hemoptysis are rare but possible.</p><p id="par0050" class="elsevierStylePara elsevierViewall">[18F]FDG PET/CT is an excellent tool for the early detection of primary/recurrence neoplasic lesions even when they cannot be identified on anatomical imaging tests. Moreover, this technique allows to detect distant metastatic disease at initial staging with the subsequently change of treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any financial support.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Rodríguez P, Herrera-Martínez Y, Sánchez Matas C, Acevedo Báñez I, Jiménez-Hoyuela García JM. Recidiva precoz detectada por [<span class="elsevierStyleSup">18</span>F]FDG PET/TC y hallazgos en la fibrobroncoscopia en paciente con metástasis traqueal múltiple de carcinoma de endometrio. Rev Esp Med Nucl Imagen Mol. 2022;41:390–391.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 489 "Ancho" => 1500 "Tamanyo" => 71565 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT shows a 10-mm nonspecific intraluminal polypoid lesion dependent on the posterior wall of the lower third of the trachea, which caused significant stenosis (1A). A few centimeters from the main lesion, 2 more polyps were located (1B).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 869 "Ancho" => 1750 "Tamanyo" => 167831 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">[18F]FDG PET/CT showed a marked increase in uptake (SUVmax of 15.8) in the lateral aspect of the lower third of the trachea (2A axial) (2B, coronal, arrow). Mediastinal and hilar lymph nodes with an SUVmax of 11.4 (2D, MIP). Fiberoptic bronchoscopy revealed a flat endotracheal lesion with a large circumferential component (2E). Simple Dumon tracheal stent placement (2F).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ovarian, uterine, and cervical cancer patients with distant metastases at diagnosis: most common locations and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Gardner" 1 => "L. Charo" 2 => "A. Mann" 3 => "D. Kapp" 4 => "N. Ramez" 5 => "R. 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