A rare case of cranial and spinal leptomeningeal dissemination of recurrent ethmoid carcinoma detected by [18F]-FDG PET/
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IMAGE OF THE MONTH
A rare case of cranial and spinal leptomeningeal dissemination of recurrent ethmoid carcinoma detected by [18F]-FDG PET/CT Kota Yokoyama 1 & Osamu Manabe 1,2 & Jyunichi Tsuchiya 1 & Jun Oyama 1 & Hiroaki Kawabe 3 & Yumiko Tateishi 3 & Takahiro Asakage 3 & Kouhei Yamamoto 4 & Ukihide Tateishi 1 Received: 29 June 2020 / Accepted: 18 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
A female in her 50s with no significant past medical history besides hypertension presented with a 2-month history of worsening dysosmia and headache. Written consent has been obtained for this study. 2-Deoxy2-[18F]fluoroglucose positron emission tomography/CT ([18F]-FDG PET/CT) revealed a marked uptake (maximal standardized uptake value, SUVmax, 26.0) in an expansile mass in the ethmoid sinus in addition to
This article is part of the Topical Collection on Image of the month. * Ukihide Tateishi [email protected] 1
Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
2
Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
3
Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
4
Department of Comprehensive Pathology, Tokyo Medical and Dental University, Tokyo, Japan
destruction of the skull base and intracranial invasion (a, b, c, d: yellow arrows). No other areas of uptake indicated no suspected distant metastasis (a). The pathological diagnosis was a poorly differentiated carcinoma with high nuclear-to-cytoplasmic ratio, mitosis, and apoptosis (e: hematoxylin and eosin stain), CAM5.2 focally positive (f), CKAE1/AE3 weakly positive (g), and all the other stains negative. A concurrent chemoradiation was performed, which resulted in complete remission in the 6-month follow-up. At the 1-year follow-up, she complained of continuous lower back pain. Another [18F]-FDG PET/CT revealed no local recurrence; however, diffuse high uptake along the spinal cord with an SUVmax of 10.5 was newly observed (e, f: red arrows). Concurrent whole-spinal MRI with contrast medium revealed diffuse leptomeningeal enhancement along the spinal cord, brainstem, and cerebellum (g, h: blue arrows), leading to a diagnosis of leptomeningeal dissemination. Leptomeningeal dissemination of ethmoid carcinoma is rare [1, 2], but whole-body [18F]-FDG PET/CT may be clinically useful to detect unexpected disseminations of recurrent carcinoma [3].
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References
Conflict of interest The authors declare that they have no conflict of interest.
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Ethical approval All procedures performed in this study involving human participant were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent to participate Informed consent was obtained from the individual participant included in the study.
Espitalier F, Michel G
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