18F-FDG PET/CT in a recurrent diffuse malignant peritoneal mesothelioma

Our plain-English summary of 18F-FDG PET/CT in a recurrent diffuse malignant peritoneal mesothelioma, by Q. Cao, M. Lu, J. Heath, et al (Clinical Nuclear Medicine, 2012).

The study

• Authors: Q. Cao, M. Lu, J. Heath, P.F. Hausner, H.R. Alexander, V. Dilsizian, W. Chen
• Journal: Clinical Nuclear Medicine
• Published: 2012;37(5):492-4
• Type of article: Case report
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is a rare and aggressive tumor. Early diagnosis of the disease is difficult, delaying effective treatment. We report a case of recurrent, biphasic, diffuse, malignant peritoneal mesothelioma. Initial abdominal computed tomography showed abnormal but nonspecific findings suggestive of an ovarian malignancy, with a negative endoscopy and laboratory studies. An abdominal exploratory laparotomy found widespread malignancy within the peritoneum with a pathological diagnosis of peritoneal mesothelioma. A PET/CT imaging showed diffusely increased metabolic activity throughout the peritoneum, with no evidence of thoracic or pleural involvement. This case demonstrates the PET/CT findings seen with malignant recurrent peritoneal mesothelioma.

In plain English

This was a short case report about one patient with recurrent malignant peritoneal mesothelioma (cancer of the abdominal lining). She was imaged with FDG PET/CT, a scan that highlights metabolically active tissue. The patient, a 48-year-old woman with no history of asbestos exposure, had fatigue and weakness for 3 years, then severe abdominal pain and a pelvic mass. Endoscopy showed no significant findings, and CT suggested ovarian cancer. Surgery found widespread cancer in the peritoneum, which was treated by extensive tumor removal and heated mitomycin C chemotherapy in the abdomen. Tissue examination showed biphasic peritoneal mesothelioma. Several months after treatment, symptoms suggested recurrence. PET/CT showed diffuse abnormal uptake along the peritoneum (SUVmax 1.9), plus uptake in an enlarged lymph node (SUVmax 2.5) and a liver lesion (SUVmax 3.4), with no evidence of cancer in the chest. Tumor markers were not raised. The authors concluded that the uptake pattern was unique and consistent with recurrent peritoneal mesothelioma, and that PET/CT could provide insight into noninvasive diagnosis and management. The report describes a single patient.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient, published as an 'interesting image')
• Who was studied: One 48-year-old woman with no history of asbestos exposure, who had fatigue and progressing weakness over 3 years
• Exposure: No asbestos exposure was reported for this patient. The study examined FDG PET/CT imaging, not an asbestos exposure.
• Main results:
  • Exploratory surgery, done for a presumed ovarian cancer, found widespread cancer within the peritoneum.
  • Tissue examination showed biphasic peritoneal mesothelioma involving multiple sites, including the pelvic wall, adnexa, uterine serosa, rectosigmoid and appendix.
  • Several months after treatment, the patient developed symptoms suspicious for recurrence.
  • In this patient, PET/CT showed diffuse abnormal FDG activity in the abdomen and pelvis corresponding to the peritoneum (SUVmax of 1.9).
  • In this patient, PET/CT also showed abnormal uptake in an enlarged portacaval lymph node (SUVmax of 2.5).
  • In this patient, PET/CT also showed abnormal uptake in a hypodense lesion in the right hepatic dome of the liver (SUVmax of 3.4).
  • There was no evidence of cancer in the chest.
  • Other imaging in this case (radiography, CT, ultrasound) showed only nonspecific abnormalities, and tumor markers were not abnormally increased.
  • The authors described the FDG distribution as unique and consistent with recurrent peritoneal mesothelioma.
• The authors' conclusion: The authors concluded that this case showed the findings of recurrent peritoneal mesothelioma on hybrid PET/CT, which they said could provide insight into potential noninvasive metabolic diagnosis and management of peritoneal mesothelioma.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Biphasic Mesothelioma, Endoscopy, Laparotomy, Peritoneum.

Related studies

• Role of 18F-FDG PET/CT in the staging of pediatric peritoneal mesothelioma — G. Abikhzer, K. Gourevich, et al. (2013)
• The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma — A. Klabatsa, S. Chicklore, et al. (2014)
• Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment — S. Basu, B. Saboury, et al. (2011)
• Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma — Y. Abe, K. Tamura, et al. (2012)
• A case of primary pericardial mesothelioma detected by 18F-FDG PET/CT — F. Aga, Y. Yamamoto, et al. (2012)
• Sarcomatoid carcinoma (carcinosarcoma) of the lung mimics malignant pleural mesothelioma on 18F-FDG PET/CT: a report of 2 cases — A. Ciarallo, W. Makis, et al. (2012)

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