PMC4897014_01
57-year-old woman with lung cancer. The PET/CT image showing hypermetabolic activity in the primary malignancy of the right lung (Arrows) and hypermetabolic activity in the pericardial region (Arrowhead), suspicion of metastatic lymphadenopathy was raised.
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It revealed high-grade uptake at the site of primary malignancy in the right lower lobe with a mean SUV of 7.8 (Fig. 1) and a 10 by 7 mm ipsilateral precarinal lymph node with mean SUV of 2.4 (not shown). In addition, it revealed a hyperactive metabolic nodular density with mean SUV of 2.4, localized anterior and to the left of the main pulmonary artery (Fig. 1-arrow).
57-year-old woman with lung cancer. The 3D views of the coronal, sagittal and transaxial views of the CT, PET and fused PET/CT showing the pericardial uptake.
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The 3D PET, CT and PET/CT fusion imaging was not more helpful to further characterize the lesion in terms of its benign or malignant nature (Figure 2).
57-year-old woman with lung cancer. Histopathology of pericardial tissue shows it to be adipose tissue.
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The gross description of the lesion was described as yellow fatty tissue of 1.5 by 1.4 by 1.0 cm in size and final diagnosis was "pericardial adipose tissue with no evidence of malignancy" (Fig. 3).
57-year-old woman with lung cancer. Histopathologic examination of primary malignancy reveals large cell type lung cancer.
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The biopsy of the primary lesion of the lung 3 months before showed a large cell (non-small cell) type cancer (Fig. 4).
57-year-old woman with lung cancer. The CD56 antibody showed the primary malignancy to be of neuroendocrine origin.
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The CD56 (Fig. 5) and synaptophysin antibody markers (Fig. 6) showed the primary lung cancer to be of neuroendocrine differentiation.
57-year-old woman with lung cancer. Six month follow-up PET/CT showing marked improvement in the primary lesion (arrow) and non-significant decrease in soft tissue pericardial density, when compared to the prior PET scan.
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Subsequent follow-up with PET/CT 6 months later (Fig. 7) showed marked improvement in the primary lesion showing photopenia with minimal rim of hypermetabolic activity and no new lesions.