18F-FDG PET/CT Imaging of Tracheal Mucoepidermoid Carcinoma

68 Ga-DOTA-FAPI-04 PET/CT Imaging of Tracheal Mucoepidermoid Carcinoma

ABSTRACT

A 23-year-old woman presented with a dry cough and dyspnea. Contrast-enhanced CT revealed an intratracheal space-occupying lesion with continuous homogeneous enhancement and airway stenosis. The patient then underwent 68 Ga-DOTA-FAPI-04 PET/CT, which showed increased uptake of FAPI-04 by the lesion. Postoperative pathology confirmed the lesion as tracheal mucoepidermoid carcinoma. This case reports a rare site of mucoepidermoid carcinoma and highlights the potential utility of 68 Ga-DOTA-FAPI-04 PET/CT for the diagnosis of tracheal mucoepidermoid carcinoma.

Mucoepidermoid Carcinomas of the Larynx

OBJECTIVES

Discussions regarding the specific management and outcomes for laryngeal MEC are limited to very small, single-institution case series. To look further into the diagnosis and management of these uncommon non-squamous cell carcinomas of the larynx, we present 3 recent cases of laryngeal MEC treated at our institution.

METHODS

Patients at a tertiary hospital treated for MEC between October 2019 and December 2020 were retrospectively identified. Chart review, imaging analysis, and histologic slide creation were completed for all patients.

RESULTS

We identified and treated 2 patients with high-grade supraglottic and 1 patient with intermediate-grade glottic MEC. These patients presented to our clinic with a primary complaint of either gradual, worsening dysphonia, dysphagia, or both. All patients underwent laryngovideostroboscopy as well as panendoscopy with directed submucosal biopsy, which was consistent with MEC. MRI was performed in 2 of the cases further elucidating the extent of submucosal spread. PET-CT was performed in all 3 cases, and none demonstrated evidence of regional or distal metastases. Surgically, high-grade MEC lesions were treated with a total laryngectomy. The intermediate MEC lesion was managed with a supracricoid partial laryngectomy (SCPL). Surgical margins were free of tumor in all cases with no nodal metastases by modified radical neck dissection. Radiation therapy was offered to both high-grade MEC patients and declined by one. Radiation was not recommended to the patient with intermediate-grade MEC as we believed that the risk of additional treatment outweighed the benefit.

CONCLUSION

We believe that MEC of the larynx should be considered in patients with atypical submucosal laryngeal masses. Laryngovideostroboscopy, MRI, and PET imaging may be valuable in determining the extent of the lesions and planning appropriate surgery. Postoperative radiation therapy should be considered a per tumor grade in other more studied sites, as there is no data on efficacy in laryngeal MEC.

18F-FDG PET/CT of Primary Tracheal Adenoid Cystic Carcinoma

ABSTRACT

Primary adenoid cystic carcinoma in the trachea is a very rare tumor. A 40-year-old woman presented with persisting cough and wheezing over 2 months. A CT scan showed a mass in the tracheal wall. The bronchoscopic biopsy confirmed adenoid cystic carcinoma. 18F-FDG PET/CT was performed to evaluate the tracheal mass, which showed an FDG-avid mass in the right posterior tracheal wall.