PMC6460839_01
Flexible nasopharyngolaryngoscopy view of the right BOT mass before treatment (a), after 3 cycles of R-CHOP chemotherapy (b) and after the completion of 6 cycles of R-CHOP chemotherapy (c)
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Fig1
Flexible laryngoscopy revealed an exophytic mass involving the right BOT that extended to the right glosso-tonsillar sulcus and beyond the midline measuring approximately 3 cm (Fig. 1). Nasopharyngolaryngoscopy also revealed no residual fullness in the area of the right BOT (Fig. 1).
a Baseline head and neck maximum intensity projection (MIP) image demonstrating focal FDG uptake in the patient's BOT HNSCC (red arrow) as well as ipsilateral cervical adenopathy (red arrowhead). b Representative axial PET/CT slice from the same time point as in (a) which delineates the BOT HNSCC (red arrow) and also highlights one of the right-sided cervical lymph nodes (red arrowhead). c Head and neck MIP image following 3 cycles of R-CHOP demonstrates complete metabolic response in the patient's BOT HNSCC and partial response in the ipsilateral cervical adenopathy (red arrowhead). d Axial PET/CT image from the same time point as (c) shows no abnormal uptake at the BOT (persistently FDG-avid cervical nodes are not shown on this slice). e Head and neck MIP image following completion of R-CHOP therapy demonstrates very subtle increased uptake in the BOT HNSCC (red arrow, barely visible) and increasing uptake in ipsilateral cervical lymph nodes (red arrowhead). Note normal physiologic activity in the vocal cords (thin red arrow). f Representative axial PET/CT image through the neck shows an FDG-avid right level III lymph node compatible with residual HNSCC. g Head and neck MIP and (h) axial PET/CT images following completion of chemoradiation therapy show no evidence of metabolically active primary or nodal HNSCC
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Fig2
Subsequently, positron emission tomography/computed tomography (PET/CT) demonstrated an FDG-avid right BOT mass (2.3 x 0.9 cm) with right-sided level IIA, IIB and III lymphadenopathy (all < 3 cm), consistent with biopsy-proven HPV-associated SCC (Fig. 2). After completion of 3 cycles of R-CHOP, PET/CT scan demonstrated interval markedly decreased size and uptake of the retroperitoneal mass, as well as interval resolution of the FDG-avid BOT lesion, and most of the FDG-avid cervical lymph nodes (Figs. 2 and 3).
a Baseline whole-body MIP image demonstrating intense FDG uptake in a large retroperitoneal mass (red arrow) compatible with patient's follicular lymphoma. b Representative axial PET/CT image from the same time point as in (a) showing the large, FDG-avid mass (red arrow). Note the common bile duct stent (red arrowhead) that is markedly anteriorly displaced by the lymphomatous mass and explains the patient's presentation with obstructive jaundice. c Whole-body MIP image following three cycles of R-CHOP shows no residual metabolically active lymphoma. d Representative axial PET/CT image from the same time point as in (c) is notable for the presence of minimal residual abnormal soft tissue in the retroperitoneum (red arrow, Lugano 2), with uptake equal to blood pool, compatible with a complete metabolic response. The common bile duct stent is in near-orthotopic location now that the retroperitoneal mass has dramatically reduced in size (red arrowhead). e Whole-body MIP image at the end of therapy, again demonstrating no metabolically active tumor. f Representative axial PET/CT image from the same time point as in (e) again depicts the complete metabolic response (Lugano 1) and also the removal of the common bile duct stent
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Fig3
There was also an intensely FDG-avid retroperitoneal mass (8.2 x 13.4 x 10.7 cm) along with left mesenteric, left periaortic, and left retroperitoneal lymph nodes (Fig. 3). After completion of 3 cycles of R-CHOP, PET/CT scan demonstrated interval markedly decreased size and uptake of the retroperitoneal mass, as well as interval resolution of the FDG-avid BOT lesion, and most of the FDG-avid cervical lymph nodes (Figs. 2 and 3).