1
|
Datta D, Kumar R, Goel AD. Utility of metabolic ratios in the diagnosis of tumor Thrombus on F-18 FDG PET/CT. EJNMMI REPORTS 2024; 8:12. [PMID: 38748073 PMCID: PMC11076428 DOI: 10.1186/s41824-024-00201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/24/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND This study aims to predict quantitative parameter in form of metabolic ratios to diagnose tumor thrombus on F-18 FDG PET/CT. METHODS This is a retrospective study from Nuclear Medicine department at All India Institute of Medical Sciences, Jodhpur, India. Patients with malignancies who underwent F-18 FDG PET/CT in our department or images sent for review from February 2020 till September 2022 were screened for tumor thrombus that comprised study group. Control group had patients with malignancy and no imaging evidence of tumor thrombus. Metabolic activities (SUVmax) of tumor thrombus, liver and descending aorta in study group, and that of IVC, liver and descending aorta in control group were recorded. Metabolic ratios of tumor thrombus to liver (SUR L) and to aorta (SUR A) in study group, and IVC to liver (SUR* L) and to aorta (SUR*A) in control group were compared using receiver operator curves. RESULTS Of 2277 studies screened, 12 had tumor thrombus. The most common primary malignant site and vessel involved were lung and IVC respectively. The median (IQR) SUR L, SUR A, SUR* L and SUR* A were 2.5 (3.25), 2.6 (6), 0.67 (0.18) and 1 (0.17) respectively. Area under ROC for SUR L and SUR A were 0.983 [95% CI: 0.955-1.0] and 0.958 [95% CI: 0.90-1.0] respectively. The ideal cut-off for SUR L was 0.953 (sensitivity 92.3%, specificity 98.0%) and for SUR A was 1.42 (sensitivity 84.6%, specificity 98.0%). CONCLUSION Metabolic ratios of tumor thrombus to liver (SUR L) and aorta (SUR A) have good diagnostic performance and can be useful in studies with non-iodinated contrast CT.
Collapse
Affiliation(s)
- Deepanksha Datta
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Rajesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Jodhpur, India.
| | - Akhil Dhanesh Goel
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
| |
Collapse
|
2
|
Yanagida Y, Amano T, Akai R, Toyoshima A, Kobayashi J, Hashimoto T, Sunami E, Kumasaka T, Sasaki S. Treatment of tumor thrombus in the superior mesenteric vein due to advanced colon cancer with complete surgical resection and chemotherapy: a case report. Surg Case Rep 2020; 6:320. [PMID: 33315157 PMCID: PMC7736432 DOI: 10.1186/s40792-020-01091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/01/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Tumor thrombus in the superior mesenteric vein secondary to colon cancer is rare. We report a case of tumor thrombus in the superior mesenteric vein and liver metastasis due to advanced colon cancer that was treated with chemotherapy and complete surgical resection. CASE PRESENTATION A 72-year-old man after transverse colectomy with lymph node dissection for advanced colon cancer was diagnosed with tumor thrombus in the superior mesenteric vein and liver metastasis. He underwent adjuvant chemotherapy and had complete surgical tumor resection involving tumor thrombectomy and hepatectomy. There has been no recurrence at 36 months after surgery. CONCLUSION Herein, we report a rare case of tumor thrombus in the superior mesenteric vein related to advanced colon cancer. The combination of chemotherapy and complete surgical tumor resection may provide long-term survival.
Collapse
Affiliation(s)
- Yoshitsugu Yanagida
- Department of Coloproctological Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Takahiro Amano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ryuji Akai
- Department of Coloproctological Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Akira Toyoshima
- Department of Coloproctological Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Jotaro Kobayashi
- Department of Cardiovascular Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Takuya Hashimoto
- Department of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo , Shibuya-ku, Tokyo, 150-8935, Japan
| | - Eiji Sunami
- Department of Surgery, Kyorin University Hospital, 6-20-2, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8953, Japan
| | - Shin Sasaki
- Department of Coloproctological Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| |
Collapse
|
3
|
Fujii Y, Kobayashi K, Kimura S, Uehara S, Takiguchi S. Ascending colon cancer accompanied by tumor thrombosis in the superior mesenteric vein: A case report. Int J Surg Case Rep 2020; 73:239-243. [PMID: 32721884 PMCID: PMC7388164 DOI: 10.1016/j.ijscr.2020.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer is seldom accompanied by venous tumor thrombosis in the superior mesenteric vein and little is known about its features. Venous tumor thrombosis is representative of an aggressive cancer and that may be a strong risk factor for the development of liver metastasis. Radical resection of the primary cancer combined with venous and adjuvant chemotherapy may be one of the treatment strategies.
Introduction Venous tumor thrombosis occasionally accompanies renal cancer, liver cancer, and pancreatic cancer. Colorectal cancer is seldom accompanied by venous tumor thrombosis in the portal vein or the superior or inferior mesenteric veins (SMV, IMV), and little is known about its features. We report a case of ascending colon cancer with tumor thrombosis in the SMV treated with right hemicolectomy and combined resection of the SMV. Presentation of case An 82-year-old man with chief complaints of loss of appetite was admitted to our hospital. He was diagnosed with ascending colon cancer accompanied with tumor thrombosis extending to the SMV. He underwent right hemicolectomy and combined resection of the tumor thrombosis and the SMV. Intestinal blood flow was evaluated by intraoperative indocyanine green (ICG) fluorography. He continued to recover well from surgery. No adjuvant chemotherapy was employed because of the patient’s advanced age and his own will. He was transferred to another hospital on postoperative day 39. Six months after surgery, abdominal CT showed multiple liver metastases. He died 8 months after surgery. Discussion and conclusions Radical resection of the primary tumor and surgical thrombectomy should be considered for the treatment of colorectal cancer without distant metastasis accompanied by tumor thrombosis. However, venous tumor thrombosis is representative of an aggressive cancer and that may be a strong risk factor for the development of liver metastasis. Adjuvant systematic chemotherapy in addition to complete surgical resection may be one of the treatment strategies.
Collapse
Affiliation(s)
- Yoshiaki Fujii
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan.
| | - Kenji Kobayashi
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan.
| | - Sho Kimura
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan.
| | - Shuhei Uehara
- Department of Surgery, Kariya Toyota General Hospital, Aichi, Japan.
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.
| |
Collapse
|
4
|
Greally M, Pilson K, Linehan A, O'Keane C, Shields CJ, Conneely JB, McCaffrey JA. Indolent Nodal Relapse of Colon Carcinoma with Associated Tumor Thrombus Invading the Superior Mesenteric Vein. J Gastrointest Cancer 2020; 50:660-664. [PMID: 29663116 DOI: 10.1007/s12029-018-0101-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Megan Greally
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. .,Gastrointestinal Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Keith Pilson
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Anna Linehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor O'Keane
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Conor J Shields
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John B Conneely
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John A McCaffrey
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| |
Collapse
|
5
|
Kim SE, Lee SJ, Cha JY, Yi SW, Kim TS, Cho IL, Kwak JY, Oh KH. Ascending Colon Cancer with Pathologically Confirmed Tumor Thrombosis of Superior Mesenteric Vein: A Case Report. Clin Endosc 2019; 52:506-509. [PMID: 30992420 PMCID: PMC6785405 DOI: 10.5946/ce.2018.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/12/2018] [Indexed: 01/10/2023] Open
Abstract
Colon cancer is very rarely accompanied by tumor thrombosis of the superior mesenteric vein (SMV). A 46-year-old patient had been diagnosed with SMV tumor thrombosis related to colon cancer without hepatic metastasis and underwent right hemicolectomy with SMV tumor thrombectomy. Tumor thrombosis was pathologically confirmed as metastatic colon cancer. There has been no recurrence for 12 months with 12 cycles of adjuvant-chemotherapy.
Collapse
Affiliation(s)
- Sung Eun Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang Jin Lee
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jun Young Cha
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang Won Yi
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Tae Sun Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Il Leon Cho
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jae Young Kwak
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Kwang Hoon Oh
- Department of Internal Medicine, Suncheon Hospital, Suncheon, Korea
| |
Collapse
|
6
|
A case of ascending colon cancer accompanied with tumor thrombosis in the superior mesenteric vein treated with right hemicolectomy and greater saphenous vein grafting. Int J Surg Case Rep 2018; 51:358-363. [PMID: 30261478 PMCID: PMC6157472 DOI: 10.1016/j.ijscr.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/17/2018] [Accepted: 09/03/2018] [Indexed: 11/23/2022] Open
Abstract
The occurrence of colorectal cancer with tumor thrombosis in the mesenteric vein is very rare. Complete resection of the primary cancer with tumor thrombosis is essential. Combined surgery and chemotherapy should be performed to prevent recurrence.
Introduction The occurrence of colorectal cancer with tumor thrombosis in the mesenteric vein is very rare. Here, we report a case of ascending colon cancer with tumor thrombosis in the superior mesenteric vein (SMV) that was treated by complete resection. Presentation of case A 48-year-old woman was initially admitted due to anemia. Ascending colon cancer coinciding with tumor thrombosis in the SMV was detected. Right hemicolectomy, tumor thrombectomy, and greater saphenous vein grafting of the SMV were performed. She underwent neoadjuvant chemotherapy with capecitabine plus oxaliplatin and did not have any recurrence. Discussion Due to the high incidence of liver metastasis, the presence of venous tumor thrombosis may influence the patient’s length of survival. Conclusion Complete resection of the primary cancer with tumor thrombosis and systemic chemotherapy should be considered for better prognosis.
Collapse
|
7
|
Mochizuki T, Abe T, Amano H, Nishida K, Yano T, Okuda H, Kobayashi T, Ohdan H, Yonehara S, Noriyuki T, Nakahara M. Characteristics of the portal vein thrombosis recurrence pattern without liver parenchymal invasion from colorectal cancer: a case report. Surg Case Rep 2018; 4:108. [PMID: 30182221 PMCID: PMC6123333 DOI: 10.1186/s40792-018-0518-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022] Open
Abstract
Background Portal vein tumor thrombosis from colorectal cancer is rare, and this recurrence pattern was mainly reported in patients with renal cell carcinoma and hepatocellular carcinoma. Furthermore, the recurrence pattern of portal vein tumor thrombosis without liver parenchymal invasion from colorectal carcinoma has not been previously reported. Herein, we present a patient with progressive portal vein tumor thrombosis without liver parenchymal invasion following curative resection. Case presentation A 61-year-old man with a chief complaint of constipation with abdominal pain associated with rectal carcinoma was admitted to our hospital. Computed tomography (CT) showed that the rectosigmoid colon wall was thickened, regional lymph nodes were swollen, and the light space-occupying lesion (SOL) was detected at segment 8 (S8). Neoadjuvant chemotherapy was performed, which was followed by laparoscopic anterior resection. The final diagnosis was stage IIIb (SS, N2, M0). After operation, systemic adjuvant chemotherapy was introduced. At first, tumor marker levels were within the normal range and there were no accumulations on positron emission tomography (PET). Tumor marker levels were elevated, and contrast-enhanced CT demonstrated that the portal vein SOL slowly extended from S8 to S5. Additionally, PET showed that the standardized uptake value was abnormally high at 5.8. Based on the diagnosis of portal vein tumor thrombosis, right hepatectomy was performed. On pathological analysis, tumor thrombosis was associated with rectal carcinoma, and there was no invasion toward the liver parenchyma. Additionally, the surgical cut end was tumor free. Six months after the hepatectomy, the paraaortic lymph nodes showed swelling. The patient is currently undergoing systemic chemotherapy. Conclusion Aggressive surgical resection should be considered in cases of portal vein tumor thrombosis. A good long-term prognosis could be obtained by a combination of curative resection and systemic chemotherapy.
Collapse
Affiliation(s)
- Tetsuya Mochizuki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Hironobu Amano
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenji Nishida
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuya Yano
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Hiroshi Okuda
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shuji Yonehara
- Department of Pathology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| |
Collapse
|
8
|
Otani K, Ishihara S, Hata K, Murono K, Sasaki K, Yasuda K, Nishikawa T, Tanaka T, Kiyomatsu T, Kawai K, Nozawa H, Yamaguchi H, Watanabe T. Colorectal cancer with venous tumor thrombosis. Asian J Surg 2016; 41:197-202. [PMID: 27693064 DOI: 10.1016/j.asjsur.2016.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/26/2022] Open
Abstract
Colorectal cancer is seldom accompanied by venous tumor thrombosis, and little is known about the features of venous tumor thrombosis in colorectal cancer. However, some reports show that colorectal cancer patients can develop venous tumor thrombosis and warn clinicians not to overlook this complication. In this report, we perform a review of 43 previously reported cases and investigate the characteristics of colorectal cancer accompanied by venous tumor thrombosis. The histological type of more than half of the cases was moderately differentiated adenocarcinoma, which is known to be aggressive. Among 41 cases with available data on liver metastasis, eight patients had synchronous liver metastasis, and liver metastatic recurrence after surgical resection was indicated in 10 patients. This liver metastatic rate was high compared to general colorectal cancer. However, 11 of 43 patients with venous tumor thrombosis could survive for more than 2 years after the diagnosis, although five of the 11 patients had liver metastasis. A long survival can be anticipated for patients following complete tumor resection and adjuvant chemotherapy. A greater accumulation of cases will help elucidate the characteristics of colorectal cancer with venous tumor thrombosis and improve the treatment strategy.
Collapse
Affiliation(s)
- Kensuke Otani
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
| | | | - Keisuke Hata
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Koji Yasuda
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | | | - Toshiaki Tanaka
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | | | - Kazushige Kawai
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, University of Tokyo, Tokyo, Japan
| | | | | |
Collapse
|
9
|
Abstract
A 48-year-old woman presented with a 2-month history of right lower extremity edema. Clinical examination only showed right lower limb swelling. Routine laboratory examination revealed no abnormal results. Abdominal ultrasonography identified uterine leiomyoma and soft tissue masses. An abdominal CT demonstrated a continuous mass extending from the right internal and external iliac vein into the common iliac vein and inferior vena cava. To distinguish the mass from malignancy, the patient underwent PET/CT scan which showed increased FDG activity in the mass. However, histopathological examination proved the mass to be IV leiomyomatosis.
Collapse
|
10
|
Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Hu S, Zhang J, Cheng C, Liu Q, Sun G, Zuo C. The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis. ACTA ACUST UNITED AC 2015; 39:1221-7. [PMID: 24913670 DOI: 10.1007/s00261-014-0170-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS In this retrospective study, we evaluated the role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in differentiating malignant from benign portal vein thrombosis (PVT) in patients with known malignant tumors. METHODS Seventy-two patients with histologically or clinically confirmed PVT and who had undergone (18)F-FDG PET/CT were included. Visual and semiquantitative analyses of PET/CT scans were performed. Metabolic activity was measured using the maximum standardized uptake value (SUVmax) by drawing the region of interest at the site of thrombosis. Receiver operating characteristic analysis was conducted to identify the optimal cutoff of SUVmax for detecting neoplastic thrombosis. Malignancy was defined using the following criteria: (1) visual analysis and (2) SUVmax >3.35. PET/CT results were confirmed with histopathological results and clinical and imaging follow-up. RESULTS The SUVmax of tumor thrombus (6.37 ± 2.67) was significantly higher than that of bland thrombus (2.87 ± 1.47; P < 0.01). The sensitivities, specificities, and accuracies for the two criteria were 91.5 % and 93.6; 64.0 and 80.0 %; and 81.9 % and 88.9 %, respectively. CONCLUSION (18)F-FDG PET/CT is a promising new method for distinguishing between portal venous neoplastic thrombosis and bland thrombosis using semiquantitative analysis, with the optimal cutoff value of SUVmax >3.35 as a criterion.
Collapse
Affiliation(s)
- Shengping Hu
- Department of Nuclear Medicine, Changhai Hospital of Second Military Medical University, 168 Changhai Road, YangPu, Shanghai, 200433, China,
| | | | | | | | | | | |
Collapse
|
12
|
Erhamamci S, Reyhan M, Nursal GN, Torun N, Yapar AF. Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol 2015; 34:287-94. [PMID: 26025479 DOI: 10.1016/j.remn.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. MATERIALS AND METHODS Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). RESULTS The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. CONCLUSION Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients.
Collapse
Affiliation(s)
- S Erhamamci
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey.
| | - M Reyhan
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| | - G N Nursal
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| | - N Torun
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| | - A F Yapar
- Department of NuclearMedicine, Faculty of Medicine, BaskentUniversity, Turkey
| |
Collapse
|
13
|
Kraft C, Schuettfort G, Weil Y, Tirneci V, Kasper A, Haberichter B, Schwonberg J, Schindewolf M, Lindhoff-Last E, Linnemann B. Thrombosis of the inferior vena cava and malignant disease. Thromb Res 2014; 134:668-73. [PMID: 25081831 DOI: 10.1016/j.thromres.2014.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/07/2014] [Accepted: 07/10/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inferior vena cava thrombosis (IVCT) is a rare event, and studies detailing its underlying aetiologies are scarce. METHODS One hundred and forty-one IVCT patients (57% females, median age 47 years) were analysed with a focus on malignancy-related thrombosis and compared with 141 age- and sex-matched control patients with isolated lower-extremity deep vein thrombosis. RESULTS Malignancies were more prevalent among IVCT patients compared with the control group (39% vs. 7.8%; P<0.001). Malignancy-related IVCT more frequently involved the suprarenal and hepatic segments of the IVC and extended more often to the right atrium than IVCT did in non-cancer patients. Among IVCT patients with malignancies, renal cell carcinoma (38%) and other malignancies of the genitourinary tract (25%) were the most common tumours. Analysis of the underlying pathological mechanisms of malignancy-related thrombosis identified external compression of the IVC by tumour masses in 9 cases (16%), and progression of malignancy into the IVC (so-called "tumour thrombosis") in 24 cases (44%). The remaining 22 cases (40%) were attributed to malignancy-related hypercoagulability and the presence of additional venous thromboembolism risk factors, such as previous surgery, immobilisation, or chemotherapy. CONCLUSIONS Malignancies substantially contribute to the risk of thrombosis involving the IVC. Tumour invasion, especially in cases of renal cell cancer and malignancy-related hypercoagulability are major triggering factors for thrombogenesis.
Collapse
Affiliation(s)
- Christiane Kraft
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Gundolf Schuettfort
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Yvonne Weil
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Vanessa Tirneci
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Alexander Kasper
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Barbara Haberichter
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Jan Schwonberg
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Marc Schindewolf
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Edelgard Lindhoff-Last
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany
| | - Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt/Main, Germany.
| |
Collapse
|
14
|
Liu Y. Migrating tumor thrombus trapped within the greenfield filter of the inferior vena cava and depicted by FDG PET/CT. Clin Nucl Med 2013; 39:214-6. [PMID: 24300365 DOI: 10.1097/rlu.0000000000000318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 72-year-old woman with leiomyosarcoma of the left thigh underwent a whole-body FDG PET/CT for staging, which demonstrated a large FDG-avid tumor in the left thigh and tumor thrombosis involving the profunda femoris artery/vein and superior femoral vein. A Greenfield filter was placed in the inferior vena cava before the radical resection of the tumor and thrombosis. Postoperative PET/CT showed an FDG-avid embolus trapped within the solid apical cap of the filter in the inferior vena cava. It was unknown if the tumor embolus migrated to the inferior vena cava before or during the surgical procedure of radical resection.
Collapse
Affiliation(s)
- Yiyan Liu
- From the Nuclear Medicine Service, Department of Radiology, Rutgers University-New Jersey Medical School, NJ
| |
Collapse
|
15
|
|
16
|
Mudalsha R, Jacob M, Pandit A, Jora C. Extensive tumor thrombus in a case of carcinoma lung detected by F18-FDG-PET/CT. Indian J Nucl Med 2012; 26:117-9. [PMID: 22174524 PMCID: PMC3237216 DOI: 10.4103/0972-3919.90269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tumor thrombus is a rare complication of solid cancers, mainly seen in cases of renal cell carcinoma, wilm's tumor, testicular carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma.[1] Tumor thrombus in inferior vena cava is a rare complication of primary carcinoma lung. It should be identified so as to rule out venous thromboembolism and avoiding unnecessary anticoagulant therapy. We describe a case where F18-Fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET/CT) helped to identify extensive tumor thrombus.
Collapse
Affiliation(s)
- Ravina Mudalsha
- Department of Nuclear Medicine, Army Hospital, Research and Referral, Delhi Cantt, New Delhi, India
| | | | | | | |
Collapse
|
17
|
Tori M, Akamatsu H, Ueshima S, Tsujimoto M, Nakahara M. Recurrent Ascending Colon Cancer Manifesting as Inferior Vena cava Thrombus. Case Rep Gastroenterol 2008; 2:181-6. [PMID: 21327176 PMCID: PMC3037984 DOI: 10.1159/000132359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report an extremely rare case of recurrent ascending colon cancer manifesting as inferior vena cava (IVC) thrombus. A 77-year-old woman previously diagnosed with ascending colon cancer underwent right hemicolectomy with lymph node dissection. Though the tumor invaded the retroperitoneum and involved the right ovarian artery and vein, curative operation was performed. The patient took 5-FU p.o. Two and a half years later, tumor thrombus in the IVC extending into the right atrium was incidentally found and diagnosed as recurrence of colon cancer by biopsy. RF-induced hyperthermia using 5-FU and CDDP i.v. was immediately performed, but she died after 6 months because of multiple liver and pulmonary metastases. In treating colon cancers invading the retroperitoneum, it should be recalled that some cases recur as tumor thrombus in the IVC and that close follow-up is therefore necessary.
Collapse
Affiliation(s)
- Masayuki Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | | | | | | | | |
Collapse
|