PMC6243340_01
A high power 400x histological image of the routine preparation.
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A high power 400x histological image of the routine preparation is shown (Figure 1).
Staging 18F-fludeoxyglucose positron emission tomography/CT scan maximum intensity projection images showing a 25-cm abdominal mass and left pelvic peritoneal nodule.
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CT imaging showed an abdominal mass measuring 21 x 11 x 14 cm and the patient was treated with one cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, ifosfamide and etoposide; however, his mass progressed to 25 x 16 x 22 cm. 18F-fludeoxyglucose positron emission tomography (18F-FDG PET)/CT scan showed a mostly necrotic 25-cm abdominal mass with a maximum standardized uptake value (SUVmax) of 18.5 with limited peritoneal disease (left pelvic nodule measuring 2.0 x 1.4 cm with SUVmax of 13.9) (Figures 2 and 3), which altered the treatment strategy from curative to palliative, and palliative radiation therapy (RT) was initiated.
Staging positron emission tomography/CT fusion (left) and CT images (right) showing abdominal and peritoneal masses.
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fig3
CT imaging showed an abdominal mass measuring 21 x 11 x 14 cm and the patient was treated with one cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, ifosfamide and etoposide; however, his mass progressed to 25 x 16 x 22 cm. 18F-fludeoxyglucose positron emission tomography (18F-FDG PET)/CT scan showed a mostly necrotic 25-cm abdominal mass with a maximum standardized uptake value (SUVmax) of 18.5 with limited peritoneal disease (left pelvic nodule measuring 2.0 x 1.4 cm with SUVmax of 13.9) (Figures 2 and 3), which altered the treatment strategy from curative to palliative, and palliative radiation therapy (RT) was initiated.
Post-radiation therapy positron emission tomography/CT scan (maximum intensity projection images) performed 4 weeks after the end of therapy showing excellent partial treatment response.
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Post RT 18F-FDG PET/CT scan performed 4 weeks after the end of therapy showed an excellent treatment response (abdominal mass SUVmax of 18.5 decreased to 7.7, pelvic mass SUVmax of 13.9 decreased to 2.4) (Figures 4 and 5).
Post-radiation therapy positron emission tomography/CT fusion (left) and CT images (right) showing treatment response in the abdominal and peritoneal masses.
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Post RT 18F-FDG PET/CT scan performed 4 weeks after the end of therapy showed an excellent treatment response (abdominal mass SUVmax of 18.5 decreased to 7.7, pelvic mass SUVmax of 13.9 decreased to 2.4) (Figures 4 and 5).
Post-surgery/chemotherapy positron emission tomography/CT scan performed 6 months after the surgery showing failure of therapy.
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Unfortunately, a post-operative PET/CT scan performed 6 months after the surgery showed new peritoneal lesions (perisplenic soft tissue SUVmax of 18.2) and numerous bone metastases in the left humerus, cervical and thoracic spine, and ribcage (Figures 6 and 7).
Post-surgery/chemotherapy positron emission tomography (bottom left), positron emission tomography/CT fusion (top left, bottom middle)/CT and CT images (top right, bottom right) showing new peritoneal and bone metastases.
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fig7
Unfortunately, a post-operative PET/CT scan performed 6 months after the surgery showed new peritoneal lesions (perisplenic soft tissue SUVmax of 18.2) and numerous bone metastases in the left humerus, cervical and thoracic spine, and ribcage (Figures 6 and 7).
A follow-up positron emission tomography/CT scan (maximum intensity projection images) performed 3 months later showing extensive soft tissue and bone progression, at which point the patient refused further chemotherapy and passed away a few months later.
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fig8
T8, and a follow-up PET/CT scan 3 months later showed extensive soft tissue progression (Figure 8). The patient refused further chemotherapy and passed away a few months later (20 months post-histological diagnosis, 12 months post-surgery/HIPEC).