Parathyroid adenoma upstaging the lung cancer
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CASE REPORT
Parathyroid adenoma upstaging the lung cancer Kursat Okuyucu • Kuthan Kavakli • Sukru Ozaydın • Serdar Karahatay • Okan Karatas • Deniz Dog˘an
Received: 14 October 2014 / Accepted: 16 December 2014 Ó The Japanese Society of Nuclear Medicine 2015
Abstract Mediastinal staging of NSCLC with noninvasive methods such as PET/CT can be misleading when a mediastinal disease accompany. Histopathologic confirmation should be made before any treatment plan. Herein, we presented a case of parathyroid adenoma upstaging the lung cancer. Keywords Lung cancer Mediastinal staging PET/CT Parathyroid adenoma
K. Okuyucu (&) O. Karatas Department of Nuclear Medicine, Gulhane Military Medical Academy, Ankara, Turkey e-mail: [email protected] O. Karatas e-mail: [email protected] K. Kavakli Department of Thoracic Surgery, Gulhane Military Medical Academy, Ankara, Turkey e-mail: [email protected] S. Ozaydın Department of Medical Oncology, Gulhane Military Medical Academy, Ankara, Turkey e-mail: [email protected] S. Karahatay Department of Otolaryngology, Gulhane Military Medical Academy, Ankara, Turkey e-mail: [email protected] D. Dog˘an Department of Chest Disease, Gulhane Military Medical Academy, Ankara, Turkey e-mail: [email protected]
Introduction In non-small cell lung cancer (NSCLC),mediastinal staging is the most crucial aspect of the entity when deciding treatment planning and determining prognosis [1–3]. According to TNM staging, N1 means ipsilateral peribronchial and/or hiler and intrapulmoner lymph nodes (LN) involvement, N2 means ipsilateral mediastinal and/or subcarinal LN involvement, N3 means contralateral mediastinal LN involvement. Primary mediastinal LN staging can be performed by several techniques including imaging techniques (Chest CT, 18F-FDG PET/CT), endoscopic techniques (Endosonography ‘EUS/EBUS’ with fine needle aspiration biopsy) and surgical staging (Cervical mediastinoscopy, VATS and VAMLA/TEMLA) [4]. When CT and/or PET/CT shows mediastinal LN positivity, tissue confirmation is usually required by endoscopic or surgical techniques. Nevertheless, upstaging of lung cancer may occur.
Case report A 55-year-old male complaining with cough has admitted for detailed examination. A spiculated lesion of 36 mm in dimension was seen on chest CT in the upper lobe of right lung. As bronchoscopic biopsy was nondiagnostic, he was explored with fine needle aspiration biopsy as squamous cell lung carcinoma. Primary staging PET/CT revealed pathologic accumulation of FDG for primary tumor (SUVmax: 11.7) and a left paratracheal lymph node (SUVmax: 22.0) (Fig. 1). This pathologic contrlateral lymph node uptake was taken as metastasis of lung cancer, thus rised mediastinal stage of the patient to T2N3M0 disease rendering him unresectable. He was treated with
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Fig. 1 The 18F-FDG PET/CT imaging before treatment of patient who was staged as T2N3M0 disease
Fig. 2 The 18F-FDG PET/CT imaging after treatment of patient that left paratracheal lymph node was stable
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