PMC8794334_01
Forty-six-year-old man with chest pain. (A) Unenhanced chest CT (soft tissue windows) at the level of the transverse aorta demonstrates a prevascular mass (M) with some punctate calcifications within it abutting and inseparable from the transverse aorta; (B) sagittal reconstruction of the chest CT (bone windows) show a poorly defined mottled sternal lesion (arrows) with cortical destruction consistent with a bone metastasis and the primary mass (M); (C) FDG PET-CT sagittal image similar in orientation to image B shows the marked FDG avidity in the primary mediastinal mass (M) and sternal metastasis (arrow).
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This demonstrated marked FDG uptake in the primary mediastinal mass with an SUV max of 19.5, as well as marked FDG uptake in the sternal metastasis with no other FDG avid foci of metastatic disease (Figure 1C).
PMC8794334_02
Forty-six-year-old man with chest pain. (A) Unenhanced chest CT (soft tissue windows) at the level of the transverse aorta demonstrates a prevascular mass (M) with some punctate calcifications within it abutting and inseparable from the transverse aorta; (B) sagittal reconstruction of the chest CT (bone windows) show a poorly defined mottled sternal lesion (arrows) with cortical destruction consistent with a bone metastasis and the primary mass (M); (C) FDG PET-CT sagittal image similar in orientation to image B shows the marked FDG avidity in the primary mediastinal mass (M) and sternal metastasis (arrow).
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This demonstrated marked FDG uptake in the primary mediastinal mass with an SUV max of 19.5, as well as marked FDG uptake in the sternal metastasis with no other FDG avid foci of metastatic disease (Figure 1C).
Following neoadjuvant therapy the mass decreased in diameter from 9.3 to 6.1 cm. The sclerotic sternal metastasis also demonstrated a partial response (not shown).
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A CT scan following neoadjuvant therapy showed a partial response with a decrease of the primary mass from 9.3 cm to 6.1 cm in diameter, and the bone metastasis had become sclerotic as a response (Figure 2).
Non keratinizing squamous cell carcinoma. (A) An infiltration of lung parenchyma (Ca, carcinoma; L, lung); (B) medium and (C) high power magnification of the neoplastic tissue. The neoplasm is composed of spindle and epithelioid cells with multiple mitotic figures (circles) and clear cellular atypia [Hematoxylin and eosin staining; magnification x100 (A), x200 (B) and x400 (C)].
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The prevascular mass was resected with adjacent pericardium and lung wedge resection that demonstrated non-keratinizing SCC invading into the adjacent lung parenchyma (Figure 3A,B,C) and into the pericardium.
Three months after completion of radiation therapy FDG PET-CT shows (A) FDG avid recurrence in the visceral mediastinum, within the pericardial recess (V), and in the subcutaneous tissue, anterior to the reconstructed chest wall (arrowhead); (B) FDG avid metastases are also seen along the pleura (arrows) and an intra-parenchymal liver metastasis (arrowhead).
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FDG PET-CT imaging demonstrated progression of FDG-avid disease in the visceral mediastinum near the posterior pericardium and pleura, as well as uptake in a 2.2 cm hepatic lesion (Figure 4A,B).
PMC8794334_03
Eighty-year-old healthy woman followed for a slowly growing pulmonary nodule. (A) Unenhanced chest CT at the level of the left pulmonary artery (LP) shows an 8 mm in short-axis diameter mediastinal lymph node (arrow) which was not present on prior (not shown) chest CT scans; (B) lung windows of the same unenhanced chest CT as in A demonstrate a 1 cm solid pulmonary nodule (black arrow); (C) FDG PET-CT at the same level of A demonstrates some FDG uptake in this new small lymph node; (D) FDG PET-CT (same as in C) demonstrates minimal FDG uptake in the left lower lobe pulmonary nodule.
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A routine follow-up CT chest demonstrated a new station 6 enlarged node (Figure 5A) and the known LLL nodule (Figure 5B). She went on to have an FDG PET-CT scan that demonstrated intense uptake in the lymph node at station 6 (Figure 5C), very low FDG uptake in the LLL nodule that was lower than the mediastinal background activity (Figure 5D), and no other abnormalities were detected in the scan.
PMC8794334_04
Thirty-three-year-old man who presented with symptoms compatible with myasthenia gravis. Contrast enhanced chest CT at presentation at the level of the left pulmonary artery (LP) demonstrates a lobular prevascular homogenous mass (arrow). Due to the relatively long length of the mass' abutment to and indistinct margin with the pericardium, the question of pericardial involvement was raised.
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Contrast enhanced chest CT imaging at presentation revealed a prevascular mass (Figure 6).
Microscopic images of tumor submitted for review by ITMIG (x100). (A) Hematoxylin and eosin staining; (B) AE1AE3; (C) CD5; (D) CD117.
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Densely packed epithelioid cells with large nuclei and distinct nucleoli admixed with only singular lymphocytes may be appreciated (Figure 7A) and the neoplastic, epithelioid cells form nests surrounded by fibrotic stroma. In Figure 7B the neoplastic cells expressed cytokeratin that confirmed their epithelial origin, and the cells were negative for CD5 (Figure 7C; positive reaction (brown) only expressed by lymphocytes) and CD117 (Figure 7D).
Follow up imaging of the 33-year-old man who initially presented with symptoms compatible with myasthenia gravis and a mediastinal mass. (A) Contrast enhanced chest CT 18 months after resection of the mediastinal mass, shows interval development of two large, up to 3 cm in diameter pleural metastases (arrows). Minute nodularity to the remaining pleura (arrowhead) may represent additional minute metastatic pleural foci. (B) Contrast enhanced chest CT at the level of the spleen (S), 18 months following resection of the pleural metastases seen in A, shows a new 5 cm x 3 cm pleural mass at the insertion of the diaphragm to the chest wall (arrows). The mass bulges through the intercostal space, suggestive of chest wall involvement. (C) FDG PET-CT at the same level as image B shows FDG uptake at the periphery of the chest wall mass.
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A contrast enhanced chest CT scan demonstrated new left pleural nodules measuring up to 3 cm in size and minute nodularity of the remaining pleura that may be additional metastatic pleural foci (Figure 8A). It bulged at the intercostal which suggested that the chest wall was likely involved (Figure 8B). A subsequent FDG PET-CT showed there was FDG uptake at the periphery of this mass (Figure 8C).