PMC6024047_01
Maximum intensity projection (MIP), axial, sagittal, and coronal F-18 FDG PET/CT images before ATT; MIP image (A) demonstrated diffusely increased FDG uptake throughout the stomach. Axial (B), sagittal (C), and coronal (D) PET/ CT images showed intense FDG uptake in the thickened gastric wall, and intra-abdominal enlarged lymph nodes
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F1
F-18 FDG PET/ CT revealed multiple hypermetabolic malignant lymphadenopathies at gastrohepatic, gastrosplenic, celiac, superior mesenteric, peripancreatic and hepatobiliary region, and paragastric region in size as 18 x 15 mm (SUVmax: 12.3) and diffuse gastric wall thickening as linitis plastica (SUVmax: 13.3), multiple hypermetabolic peritoneal implants in the omentum (SUVmax: 5.7) and peritoneum, and mild hypermetabolic suspected malignant lymph nodes at left supraclavicular region (Fig. 1).
Gastric ulcer on incisura angularis
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F2
Gastric ulcer at incisura angularis was detected on upper GI endoscopy (Fig. 2).
Langhans-type giant cells (black arrow), granulomas composed of epithelioid histiocytes (red arrow) (H&E 200*)
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F3
Histopathology of the lymph nodes extracted by exploratory laparotomy revealed granulamatous lymphadenitis with granulomas including giant cells, mostly suspecting TB (Fig. 3).
Follow-up F-18 FDG PET/CT images [maximum intensity projection (A), axial (B), sagittal (C), and coronal (D)] exhibited complete response to ATT with no residual disease
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F4
The F-18 FDG PET/ CT images (maximum intensity projection, CT, and fusion PET/ CT) exhibited a complete response to ATT with no residual disease (Fig. 4).