Clinical History
59-year-old lady recently diagnosed with nasopharyngeal carcinoma. PET CT for staging.
Findings
There is a hypermetabolic FDG-avid left nasopharyngeal soft tissue mass, obliterating the left fossa of Rosenmuller (SUVmax of 9.3, delayed SUVmax 11.0). Superiorly it extends into the roof of the nasopharynx and crosses the midline. It also involves the floor of the sphenoid sinus, left pterygoid plates, with further extension of activity into the left cavernous sinus. Laterally, it involves the left paraphryngeal space and is inseparable from the FDG-avid left retropharyngeal node. No abnormal FDG-avid focus is seen in the pterygopalatine fossae and oropharynx. The paranasal sinuses and mastoids are clear. No focal area of abnormal increased metabolic activity is detected to suggest presence of FDG avid metastatic disease in either of the cerebral hemispheres or cerebellum.
Enlarged thyroid gland with low grade activity is present, most likely physiological in origin. The subcentimeter bilateral intra-parotid nodes and the subcentimeter bilateral level II cervical nodes of low grade avidity, as well as the ametabolic subcentimeter submandibular, submental, bilateral axillary nodes, aortopulmonary, precarinal and right paratracheal node are more likely to be reactive in the origin. There is no evidence of FDG avid mediastinal, hilar or supraclavicular lymphadenopathy. No suspicious pulmonary nodules are detected. No pleural or pericardial effusion is seen.
No focal area of abnormal increased glycolysis is detected within the liver, adrenals or spleen. Incidental gall stones are noted. The mildly FDG avid subcentimeter left external iliac nodes are most likely reactive in origin. There is no evidence of FDG avid abdominal, pelvic or retro-peritoneal lymphadenopathy.
Marrow activity appears to be within normal limits.
Clinical Impression
Hypermetabolic FDG left nasopharyngeal tumoral mass, with extension as described above is present.
A FDG-avid left retropharyngeal nodal metastasis that is inseparable from the nasophayngeal mass is noted. There are no other FDG avid metastatic nodes seen elsewhere.
No FDG avid distant metastatic foci are detected.
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