Clinical History
58 years old gentleman with sino-nasal NK/T cell lymphoma. The patient is status post chemotherapy from Jun till Aug 09. PET/CT to assess treatment response.
Findings
Comparison was made with the previous PET study of 8 Jun 2009.
The previously noted hypermetabolic FDG avid mass within the nasal cavity and nasopharynx shows no significant change in FDG activity (maxSUV 11.6 vs 11.9 previously). Currently there is still FDG-avid inferior tumoural involvement of the left palatine tonsil, lateral tumoural extension into the left parapharyngeal and retropharyngeal space, left infra-temporal fossa, bilateral pterygopalatine fossae, bilateral pterygoid plates, left medial and lateral pterygoid muscles, left maxillary sinus (with involvement of the anterior, medial and postero-lateral walls of the left maxillary sinus as well as the alveolar process on the left side of the maxilla). There is also superior extension into bilateral ethmoid sinuses, floor of the sphenoid sinuses and medial aspect of the left orbit.
The ametabolic opacification of the frontal sinuses and right maxillary sinus is more likely to be due to obstructed secretions or sinusitis. The diffuse intense activity involving the tongue is more likely to be physiological in origin.
There are no FDG avid cervical, supraclavicular, axillary or mediastinal nodes. The non FDG avid subcentimeter bilateral level II jugular/cervical nodes, bilateral submandibular nodes and precarinal node of negligible to low grade activity are compatible with reactive nodes. The subcentimeter calcified left lower paratracheal node is most likely granulomatous origin.
No FDG-avid focus or nodules are detected in the lungs. Mild scarring is present in the right lower lobe. No pleural or pericardial effusion is seen.
Below the diaphragm, there are no FDG avid intra-abdominal, retroperitoneal, pelvic or inguinal nodes.
The subcentimeter non FDG-avid hypodensities in segment VII of the liver are most likely cysts. No abnormal FDG-avid focus is detected within the liver, spleen, pancreas or adrenal glands. A non FDG-avid left renal cyst is present.
The diffuse mildly increased bone marrow activity is most likely related to the recent chemotherapy.
Clinical Impression
The hypermetabolic FDG avid sino-nasal lymphomatous mass is relatively unchanged in extent of involvement and FDG activity.
There are no FDG-avid nodes above and below the diaphragm.
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