18F-FDG PET/CT detected mediastinal small-cell neuroendocrine carcinoma with all cardiac cavities metastases
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Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
Received Nov 7, 2020; accepted Nov 10, 2020 doi:10.1007/s12350-020-02443-3
INTRODUCTION
CASE SUMMARY
With the exception of small-cell lung cancer, neuroendocrine neoplasm is a rare entity with an incidence of 2.5 to 5 per 100,000 and is most common in gastrointestinal tract and pancreas (60%), while mediastinal small-cell neuroendocrine carcinoma is an extremely rare condition.1,2 Small-cell neuroendocrine carcinoma is a highly malignant tumor that can proliferate rapidly to form large masses and invade the surrounding area, resulting in poor prognosis.2,3 Given the poor condition of invading heart, the accumulation of radiological signatures in such patient could help early identification of this rare entity to improve patient survival.
A 24-year-old woman came to our hospital with the chief complaint of shortness of breath on exertion of 1 year duration. Electrocardiogram showed sinus tachycardia, QT interval prolongation, and T-wave changes (Figure 1). Echocardiography showed several echogenic masses with unclear boundaries in the cardiac cavities (Figure 2). FDG PET/CT imaging showed a large mediastinal mass and masses in the lungs, pericardium, and all cardiac cavities, with increased uptake of FDG (Figure 3). Mediastinal biopsy revealed mediastinal small-cell neuroendocrine carcinoma (Figure 4). She received cisplatin and etoposide chemotherapy and sadly died 14 months later. FDG PET/CT imaging is very useful for diagnosis of mediastinal small-cell neuroendocrine carcinoma, and early diagnosis may improve the prognosis of such patients.
Funding None. Reprint requests: Shengcai Huang, MD, Department of PET/CT, First Affiliated Hospital of Guangxi Medical University, Nanning530021, Guangxi Zhuang Autonomous Region, China; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Yang et al. 18F-FDG PET/CT detected mediastinal small-cell neuroendocrine
Journal of Nuclear CardiologyÒ
Figure 1. Electrocardiogram indicated sinus tachycardia, heart rate 108 beats per minute, QTc was 536 ms, T-wave changes.
Figure 2. Echocardiography showed multiple masses with unclear boundaries in the left ventricular cavity (A measuring, 3.05 9 2.00 cm), left ventricular wall (B measuring, 3.86 9 3.22 cm), right ventricular cavity (C measuring, 2.24 9 1.28 cm), right ventricular wall (D measuring, 3.03 9 2.72 cm), and right atrium (E measuring, 7.75 9 3.46 cm). Also, pericardial effusion was detected.
Journal of Nuclear CardiologyÒ
Yang et al. 18F-FDG PET/CT detected mediastinal small-cell neuroendocrine
Figure 3. FDG PET/CT whole body MIP image demonstrated increased uptake of FDG in mediastinum, lungs, pericardium, all cardiac chambers, hilar lymph nodes, and para-aortic lymph node (A). FDG PET/CT showed lesions with uniform density and increased glucose metabolism in the mediastinum (measuring, 11.0 9 3.7 cm; SUVmax, 9.7), lungs (SUVmax,
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