Detection of an Asymptomatic Right-Ventricle Cardiac Metastasis from a Small-Cell Lung Cancer by F-18-FDG PET/CT Maria Victoria Orcurto, MD, Angelika.

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Detection of an Asymptomatic Right-Ventricle Cardiac Metastasis from a Small-Cell Lung Cancer by F-18-FDG PET/CT Maria Victoria Orcurto, MD, Angelika Bischof Delaloye, MD, Igor Letovanec, MD, Martina Martins Favre, MD, John O. Prior, MD, PhD Journal of Thoracic Oncology Volume 4, Issue 1, Pages 127-130 (January 2009) DOI: 10.1097/JTO.0b013e318189f60e Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Maximal intensity projection image (MIP) of: A, pretherapeutic positron emission tomography/computed tomography (PET/CT) showing increased uptake of 18F-fluorodeoxyglucose (FDG) in the large lung tumor of the upper right lobe (*) with central necrosis (standardized uptake value [SUVmax] from 15 to 25 g/ml). Note also a high uptake in the right hilar and mediastinal lymph nodes. Focal increased uptake is visualized in the right ventricle corresponding to the heart metastasis confirmed later (arrow). B, Follow-up PET/CT several weeks after chemo-radiotherapy. The cardiac lesion (arrow) as well as mediastinal and hilar lymph nodes show no longer increased tracer uptake while the residual lung tumor still accumulates 18F-FDG (SUVmax 20 g/ml). Journal of Thoracic Oncology 2009 4, 127-130DOI: (10.1097/JTO.0b013e318189f60e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 A, Transaxial images of the pretherapeutic computed tomography (CT), positron emission tomography (PET)/CT fusion and PET showing the cardiac metastasis appearing as a focal 18F-FDG uptake in the right ventricle (SUVmax 13 g/ml) and a hypodense area on native CT (arrow). B, On the posttherapy PET/CT the cardiac metastasis is no longer visible. Journal of Thoracic Oncology 2009 4, 127-130DOI: (10.1097/JTO.0b013e318189f60e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Ventriculography performed during right ventricle catheterization showing an apical mass molded by the contrast agent (arrow). Journal of Thoracic Oncology 2009 4, 127-130DOI: (10.1097/JTO.0b013e318189f60e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 H&E staining of the endomyocardial biopsy (40×, insert 200×): fragments of myocardium and groups of densely packed small tumoral cells can be seen; the insert is detailing scant cytoplasm, finely granular nuclear chromatin, nuclear molding, absent nucleoli and extensive necrosis. Immunostaining (not shown) revealed positive cytoplasmic markers for a tumor of neuroendocrine origin (synaptophysin+, chromogranin+ and CD56+). Journal of Thoracic Oncology 2009 4, 127-130DOI: (10.1097/JTO.0b013e318189f60e) Copyright © 2009 International Association for the Study of Lung Cancer Terms and Conditions