Indian Journal of Nuclear Medicine

INTERESTING IMAGES
Year
: 2014  |  Volume : 29  |  Issue : 1  |  Page : 53--54

Leptomeningeal carcinomatosis as only pathological finding at FDG-PET/CT in case of tumor marker elevation in breast cancer


Maria Luz Dominguez Grande, Juan Ignacio Rayo, Justo Serrano, Jose Rafael Infante, Lucia Garcia, Carmen Duran, Felipe Gomez-Caminero 
 Department of Nuclear Medicine, Hospital Universitario "Infanta Cristina", Badajoz, Spain

Correspondence Address:
Maria Luz Dominguez Grande
Department of Nuclear Medicine, Hospital Universitario «DQ»Infanta Cristina«DQ», Badajoz
Spain

Abstract

Leptomeningeal carcinomatosis is an infrequent disease and although its treatment is palliative, earlier diagnosis will lead to prolonged survival and improve functional outcome. Whole-body FDG-PET allows the entire spinal cord to be examined noninvasively, so close attention should be paid to the spinal canal, since these lesions can easily be mistaken for physiologic uptake, sometimes there is no clinical suspicion and may occur without concurrent active cancer. We present a female patient with a history of carcinoma of the breast, who presented an elevation of serum tumor marker CA 15-3. An FDG-PET/CT study only revealed multiple abnormal uptake at the vertebral foramen at thoracic and lumbosacral regions suggesting leptomeningeal metastases that were confirmed by MRI and cerebrospinal fluid cytology.



How to cite this article:
Grande MD, Rayo JI, Serrano J, Infante JR, Garcia L, Duran C, Gomez-Caminero F. Leptomeningeal carcinomatosis as only pathological finding at FDG-PET/CT in case of tumor marker elevation in breast cancer.Indian J Nucl Med 2014;29:53-54


How to cite this URL:
Grande MD, Rayo JI, Serrano J, Infante JR, Garcia L, Duran C, Gomez-Caminero F. Leptomeningeal carcinomatosis as only pathological finding at FDG-PET/CT in case of tumor marker elevation in breast cancer. Indian J Nucl Med [serial online] 2014 [cited 2020 Feb 20 ];29:53-54
Available from: http://www.ijnm.in/text.asp?2014/29/1/53/125779


Full Text

Leptomeningeal carcinomatosis (LC) is a rare and devastating disease consists of cerebral spinal fluid dissemination of malignancy with invasion into the meninges. Although the prognosis is poor with patient survival of several months, early diagnosis is important in order to relieve symptoms, improve or stabilize the neurologic status, and prolong survival with the treatment. [1],[2]

We present a 47-year-old female patient with a history of invasive ductal carcinoma of the breast, who had been treated with mastectomy, axillary nodal evacuation, hormone therapy and locoregional radiotherapy. Three years after the achievement of complete remission, the patient presented a progressive elevation of serum tumor marker CA 15-3 (68.3 U/ml, range < 28). A thoracoabdominal computerized tomography (CT), Tc-99m bone scan and an F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT were performed, but there was no evidence of recurrence or metastases. Nine months later CA 15-3 still remained raised (49.3 U/ml, range < 28) and after a week of moderate sciatica pain, an FDG-PET/CT study was repeated to evaluate for recurrent disease. It was performed 60 min after the intravenous injection of 281 MBq (7.6 mCi) F-18 FDG, subsequent to a 6-h fast with a whole body full ring PET/CT camera (Discovery LS GE, USA). The only finding was an abnormal FDG accumulation at the vertebral foramen at thoracic and lumbosacral regions. These FDG avid lesions were located at the level of T2 vertebra (maximum standardized uptake value [SUVmax] 3.0), T6 (SUVmax 5.8), T8 (SUVmax 3.0) [Figure 1]a, T11 (SUVmax 2.1), L5 (SUVmax 2.5) and at the level of sacrum (SUVmax 4.1) [Figure 1]b, suggesting diffuse leptomeningeal metastasis. The patient was referred for gadolinium contrast spinal MRI and it showed enhancing linear and nodular thickening on the cord surface [Figure 1]c highly suggestive of LC. Cytological examination of the cerebrospinal fluid was performed, and it was reported as positive for malignant cells, confirming the diagnosis of LC.{Figure 1}

About 2-5% of patients with breast cancer may develop LC, [3] being the most common solid tumor to exhibit leptomeningeal colonization. [4] It is common for most patients to have intraparenchymal brain metastases concurrent with LC [5] and widely disseminated cancer. MRI is very useful for the diagnosis of LC, but it is almost always performed when the patient is symptomatic. Occasionally, as the case we present, leptomeningeal metastasis can be the only site of distant recurrence. [6] As clinical signs and symptoms of LC may be absent or may underestimate the extent of macroscopic disease, [1] so when performing a FDG-PET/CT to look for distant metastatic sites, close attention should be paid to the entire spinal canal, since these lesions can easily be mistaken for physiologic uptake.

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