Cervical Cancer - Cervical Cancer Case Study

Clinical History
A 26 year old female patient with a history of cervical cancer, treated with hysterectomy, radiation therapy and chemotherapy in 2003, presented for a restaging PET•CT study. A previous PET scan, performed in March 2005, showed bilateral hypermetabolic inguinal adenopathy which was regarded as inflammatory, secondary to the hysterectomy. No well defined metastases were identified in initial PET study.

Imaging Findings

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The FDG PET•CT study showed three focal hypermetabolic areas in the liver, consistent with metastatic disease. There was also a focal area of hypermetabolism in a left paraaortic lymph node, suggestive of interval metastases, in the body of the T1 vertebra and in the right transverse process of the L3 vertebra, suggestive of osseous metastases. The rest of the body showed normal radiotracer distribution. There was no evidence of hypermetabolic cervical nor supraclavicular, hilar or mediastinal adenopathy. Both lung fields were clear.

Discussion
This case study illustrates the advantage FDG PET•CT sequential follow up studies can have in accurate evaluation of the patient's disease burden. Discovery of multiple hepatic, paraaortic and skeletal metastases made a drastic change in chemotherapy regime and overall portrayed a very adverse prognostic indication. The paraaortic lymph node was 1.5 cm in size and was delineated on the CT component of the PET•CT. However, the anterior right lobar liver lesion did not show any changes on the CT scan. The bone lesions were also unremarkable on the CT scan.

Data courtesy of Dr. Charles Intenzo and Dr. Sung Kim, Jefferson Center City Imaging, Philadelphia, PA