PMC5966541_01
18FDG PET/CT performed before lenvatinib administration. Besides the numerous bilateral lung metastases, note the intense uptake by two locally recurrent lesions in the neck and by the cavernous sinus metastasis.
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F1
A subsequent 18FDG PET/CT scan showed intense glucose metabolism in the basisphenoid region (Figure 1) and a gadolinium-enhanced brain MRI scan revealed a mass in the right cavernous sinus measuring 2.5 cm x 2.0 cm x 1.8 cm, with a low signal in
MRI brain scans performed before (A-C) and one month after (D-F) the administration of lenvatinib. The right cavernous sinus metastasis completely encapsulates a consistent portion of the intracranial tract of the right internal carotid artery.
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T2 and enhancement on post-contrast images, which was compatible with a metastasis. The lesion encapsulated a 2-cm segment of the right internal carotid artery, without causing luminal narrowing (Figures 2A-C). An MRI performed about 30 days later showed that the metastasis in the right cavernous sinus was significantly smaller and that the integrity of the internal carotid was preserved (Figures 2D-F).
Ultrasound scan of a locally recurrent neck lesion in right supraclavicular region. (A) Imaging before lenvatinib start. (B) Ultrasound scan after 1 month of therapy at 10 mg daily. Tumor vascularization is significantly reduced. (C,D) Progressive tumor reduction after 2 (C) and 6 months (D) of treatment at the same dose.
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F3
Basal Tg declined to 338.4 ng/ml without Tg-Ab, in line with a reduction in neck lesions volume (Figure 3).