18075433

F-18 FDG PET/CT Illustrating Tumor Invasion in the IVC From Adrenocortical Carcinoma

Mei-Fang Cheng, MD, Yen-Wen Wu, MD, Kai-Yuan Tzen, MD, and Ruoh-Fang Yen, MD, PhD

Abstract: Tumor thrombus in the inferior vena cava (IVC) is a rare complication of adrenocortical carcinoma (ACC). We present a right ACC that was found on a routine health checkup and was confirmed by simultaneous measurements of late-afternoon serum cortisol and ACTH levels in a 65-year-old woman. Preoperative F-18 FDG PET/CT revealed intense F-18 FDG uptake in the right adrenal region with tumor invasion in the IVC. This PET result was also confirmed by subsequent abdominal MRI. The patient then had a right adrenalectomy with IVC thrombectomy. Pathologic analysis of the right adrenal tumor and the thrombus from the IVC was consis- tent with ACC.

Key Words: adrenocortical carcinoma, F-18 fluorodeoxyglucose, positron emission tomography, PET/CT, tumor thrombus, IVC invasion

(Clin Nucl Med 2007;32: 891-892)

Received for publication April 26, 2007; revision accepted June 17, 2007.

From the Department of Nuclear Medicine, National Taiwan University Hospi- tal and National Taiwan University College of Medicine, Taipei, Taiwan.

Reprints: Ruoh-Fang Yen, MD, PHD, Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan. E-mail: rfyen@ntu.edu.tw.

Copyright @ 2007 by Lippincott Williams & Wilkins ISSN: 0363-9762/07/3211-0891

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FIGURE 1. A right adrenocortical carcinoma in a 65-year-old woman was found in a routine health checkup and was con- firmed by simultaneous measurements of late-afternoon serum cortisol and ACTH levels. A, Preoperative F-18 FDG PET/CT demonstrated intense radiotracer uptake in the primary tumor (arrows) and tumor thrombus in the IVC (arrowheads). B, Sub- sequent postcontrast T2 sequence coronal MRI revealed a large filling defect within the IVC (arrowhead). Adrenocortical carci- noma is a highly malignant tumor with poor prognosis.1,2 Complete and aggressive surgery remains the mainstay of treat- ment. Several studies have reported promising results of F-18 FDG PET in evaluating adrenal cancers.3,4 Furthermore, the combined PET/CT enhancement enables us to better localize tumor spread. Vascular thrombosis is a rare complication of many malignant and benign diseases.5-8 For this patient, combined PET and CT technology pinpoints the location of the le- sions and is a help to avoid the incorrect interpretation of liver metastasis that may be concluded from PET imaging alone.

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