Clinical History
40 year old lady with recently diagnosed nasopharyngeal carcinoma. PET/CT for staging.
Findings
A moderately FDG-avid mass (maxSUV 10.9) is noted involving the left Fossa of Rosenmuller and roof of the nasopharynx with extension across the midline. No definite intracranial extension is present superiorly. Anteriorly, the mass extends to the left posterior choana. It is abutting the left medial pterygoid plate but no definite involvement is present. There is no inferior extension of the mass to involve the oropharynx. No FDG-avid focus is seen in the parapharyngeal spaces, pterygopalatine fossae, infratemporal fossae, clivus and the rest of the skull base. The paranasal sinuses and mastoids are clear.
A moderately FDG-avid left retropharyngeal nodal metastasis is detected (maxSUV 3.6). The left level II node of low grade activity (maxSUV 2.2) is more likely to be reactive in origin. No other FDG-avid cervical, supraclavicular or mediastinal nodes are noted. The other non FDG-avid subcentimeter right level II and III nodes, left level II, III and V nodes, submental node, bilateral submandibular nodes, right paratracheal node, precarinal node and bilateral axillary nodes are more in keeping with reactive nodes.
No FDG-avid focus is seen in the lungs. The tiny subcentimeter nodule in the right upper lobe is too small to be accurately resolved on PET and is indeterminate on CT. Linear atelectasis is noted in the right middle lobe. No pleural effusion or pericardial effusion is seen.
There are no FDG-avid intra-abdominal or retroperitoneal nodes. No abnormal FDG-avid focus is noted in the liver, spleen, pancreas or adrenal glands. The mildly increased endometrial activity is more likely to be physiological in origin in the reproductive age group. A tiny right renal calculus is seen.
The bone marrow shows normal physiological distribution of FDG activity.
Clinical Impression
A FDG-avid nasopharyngeal tumoural mass is demonstrated.
A FDG-avid left retropharyngeal nodal metastasis is present. No other FDG-avid cervical or supraclavicular nodes are seen.
No FDG-avid distant metastases are noted.
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