PET/CT demonstration and monitoring of thoracic and abdominal wall mesothelioma

Our plain-English summary of PET/CT demonstration and monitoring of thoracic and abdominal wall mesothelioma, by B.D. Nguyen (Clinical Nuclear Medicine, 2014).

The study

• Author: B.D. Nguyen
• Journal: Clinical Nuclear Medicine
• Published: 2014;39(1):e106-9
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma is a malignancy arising from the embryonic coelomic mesodermal lining forming the pleura, peritoneum, pericardium, and tunica vaginalis. It is mostly induced by exposure to asbestos. The author presents a 77-year-old woman with an atypical manifestation of epithelioid mesothelioma, which does not follow the expected clinical characteristics of this disease mentioned above. In this case, PET/CT provides useful information concerning the extension of the lesions to thoracic and abdominal walls not fully evaluated by the initial conventional cross-sectional imaging. PET/CT also allows an accurate therapeutic monitoring of the disease.

In plain English

This article was a single case report from the Department of Radiology at Mayo Clinic in Scottsdale, Arizona, published in the journal's "Interesting Image" section. It described a 77-year-old woman who came in with an enlarging, tender mass of the right breast and chest wall that was suspected to be breast cancer. Breast MR and ultrasound found no breast lesion but showed a mass growing into the right pectoralis (chest) muscles. Biopsy showed malignant epithelioid mesothelioma. The patient denied any past asbestos exposure. Her history included talc pleurodesis on the left side 9 years earlier. FDG PET/CT scanning showed tumor in the right pectoralis muscles extending to the right armpit, increased activity in the abdominal wall muscles suspicious for more mesothelioma, and benign uptake from the old talc pleurodesis. Imaging found no pleural or peritoneal source of the mesothelioma. After radiation and carboplatin and pemetrexed chemotherapy, the chest wall lesions improved but the abdominal wall disease worsened. The author concluded that PET/CT showed how far the disease had spread and how it responded to treatment.

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, imaging case presentation)
• Who was studied: one 77-year-old woman seen at Mayo Clinic, Scottsdale, Arizona, with an enlarging, tender right breast and chest wall mass; biopsy showed malignant epithelioid mesothelioma
• Exposure: No asbestos exposure was identified: the patient denied any past exposure to asbestos. Her medical history included a left spontaneous pneumothorax treated with talc pleurodesis 9 years earlier. The article describes this only as a source of benign tracer uptake on PET/CT and does not discuss it as a cause.
• Main results:
  • Breast MR and ultrasound found no breast lesion but showed an ill-defined mass infiltrating the right pectoralis muscles.
  • PET/CT showed malignant involvement of the right pectoralis muscles extending to the right axilla (armpit).
  • PET/CT showed diffuse increased metabolic activity in the abdominal muscles, mainly on the right side, which was suspicious for additional sites of mesothelioma.
  • PET/CT showed benign tracer uptake from the earlier left-sided talc pleurodesis.
  • Initial and follow-up cross-sectional imaging did not detect any pleural or peritoneal source of the mesothelioma.
  • The patient was treated with radiation therapy to the right chest wall lesion together with carboplatin and pemetrexed chemotherapy.
  • After treatment, PET/CT showed improvement of the right chest wall lesions.
  • After treatment, PET/CT showed worsening of the abdominal wall mesothelioma, and further radiation with chemotherapy was planned.
• The authors' conclusion: The author concluded that PET/CT showed the extent of the mesothelioma in the right pectoralis muscles and in the anterior abdominal wall muscles on both sides. In the author's words, this emphasized the importance of functional imaging for staging. The author added that PET/CT also showed the effect of radiation on the chest wall and the need for further treatment of the abdominal wall tumor.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleura, Peritoneum, Pericardium, Tunica Vaginalis, Epithelioid.

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