May I get your comment on what the following results show? 76YO Male, colon bisection in 2003 for cancerous polyps and possible lymph node. CT scan in 7/06 showed no abnormalities. Thank you.
The heart size is within normal limits. There is no pericardial effusion or thickening. Coronary arteries calcifications are noted. The thoracic aorta enhances appropriately. Scattered calcifications are noted throughout the aorta.
A 3.4 x 2.5 cm soft tissue mass is seen at the LEFT hilum. It is spiculated and extends into a reticulonodular pattern superiorly and laterally to the pleural margin in the LEFT upper lobe. This is most likely a neoplasm.
A nodular density is seen in the RIGHT upper lobe along the minor fissure. It measures approximately 7 mm this was not demonstrated on prior study. In the posterior aspect of the RIGHT lower lobe there is a pleural based nodule measuring approximately 7 mm, it does not appear significantly changed since 2006. Emphysematous changes are seen bilaterally.There is a small amount of pleural thickening medially at the RIGHT base. No pleural effusion is seen.
Several mildly enlarged lymph nodes measuring up to 14 mm in short axis are present at the AP window. Small calcified lymph nodes are noted in the paratracheal and subcarinal regions. No pathologically enlarged lymph nodes are seen at the RIGHT hilum or axillary regions.
No focal lesion is seen within the visualized structures of the upper abdomen. Tiny calcifications noted in the spleen are likely representing granulomas.
Degenerative change are present in the thoracic spine.
Soft tissue mass at the LEFT hilum extending into the LEFT upper lobe most likely representing a neoplasm.
Subcentimeter nodules within the RIGHT lung.
According to the report, the situation is worrying. There appears to be likelihood of lung cancer.
Please consult an oncologist urgently for appropriate investigation (biopsy or FNAC), staging, and treatment.
All the best, and God Bless!
Here is the follow-up PET scan for my father. Opinions, please, on metastasis, possible treatment options and timeframe? Is surgery viable? VATS? He has a brain CT scan scheduled this week. Thank you very much.
Skull base and neck: No mass, adenopathy or focal abnormal FDG uptake is identified in the neck. There are moderate degenerative changes in the cervical spine.
Thorax: A central LEFT upper lobe/LEFT hilar mass is again noted, not significantly changed from the recent CT chest dated 5/1/2009. The mass shows markedly abnormal FDG uptake with maximum SUV of 19.2. This is highly suspicious for malignancy. There is a mildly enlarged LEFT hilar lymph node which shows abnormal FDG uptake likely resenting a metastasis. No other sites of abnormal FDG uptake are identified in the chest. Calcified granulomas are noted in the pretracheal and subcarinal regions and as well as the RIGHT hilum. Atherosclerotic calcifications involve the coronary arteries and aorta. There is mild adenopathy in the aortopulmonic window. Increased activity is seen within several of these lymph nodes. The lymph node with the greatest uptake in the AP window has maximum SUV of 5.3 Peripheral to the LEFT upper lobe mass is a vague reticulonodular infiltrate which shows only mildly elevated FDG uptake with SUV of 1.9. This is probably post obstructive infiltrate although lymphangitic spread of tumor is not entirely excluded.
Abdominal images show a few granulomas in the spleen. Otherwise, the liver and spleen are not remarkable. The gallbladder, pancreas, adrenal glands and kidneys are normal. No mass or adenopathy is seen. There is no intestinal distention. There is no focal abnormal FDG uptake in the abdomen or pelvis. No ascites is seen mild degenerative findings are present in the spine.
IMPRESSION: The soft tissue mass at the superior aspect of the LEFT hilum involving the LEFT upper lobe shows abnormal FDG uptake consistent with malignancy. This may represent a primary lung carcinoma. Considering the patient's history of colon carcinoma, metastatic disease is not entirely excluded. Adenopathy in the aortopulmonic window and LEFT hilum also shows increased activity and is most likely metastatic adenopathy. Peripheral LEFT upper lobe infiltrate probably is due to to postobstructive infiltrate although lymphangitic spread of the neoplasm is not entirely excluded. No metastatic disease is identified in the abdomen or pelvis.
Both the CT scan and the PET scan show a suspicious mass in the left lung with enlarged lymph nodes showing uptake. Also it appears that the disease is confined to the left lung and hilar and mediastinal lymph nodes and there are no metastasis elsewhere. At this point, a biopsy or an FNAC from the mass is needed to confirm the diagnosis. An IHC of this biopsy material may be necessary to confirm the origin of this mass - primary lung versus metastatic colon.
If the biopsy shows cancer the treatment options include radiation therapy, chemotherapy, surgery and various combinations of these. Once the diagnosis is established, the treatment options are best discussed in a multidisciplinary team comprising of a surgical, medical and radiation oncologist. The optimal combination and sequencing of therapy can be decided based on the stage of the disease and the patient’s general condition.
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