Malignant Tumors with Low FDG-PET Uptake: A case Report and Review of the Literature

Abstract

Background Fluorine 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-accepted examination for diagnosis, staging, and monitoring in clinical oncology.1 According to the higher glucose metabolism rate, malignant tumor cells have higher FDG uptake, besides higher FDG uptake is strictly correlated with poor prognosis in various types of cancer.2 However, FDG-PET has limitations associated with some of the cancer types that have low FDG uptake, even high metabolism.3 Low cellularity, low glucose metabolism, inadequate patient preparation, small-sized tumor, and cellular mucin might be cause to low FDG uptake.4 Low FDG uptake frequently presented in lepidic growth adenocarcinoma (formerly defined as bronchoalveolar adenocarcinoma), renal cell cancer, and mucinous neoplasms. Case Report We report on a case of 57-year-old female biopsy proven Signet Ring Cell Carcinoma (SRCC) patient without FDG-PET uptake in the evaluation for staging. The patient admitted to hospital with massive ascites and dyspeptic complaints. Further evaluation revealed the existence of SRCC with no FDG-PET uptake. Conclusion FDG-PET reveals valuably findings in clinical oncology for diagnosis, staging, and monitoring. Although FDG-PET uptake is correlated with most of the malignant tumors’ activity, some aggressive malignancies may have no/low FDG uptake and FDG uptake is not predictive of survival.

Keywords

• signet ring cell carcinoma,srcc,low fdg uptake,low pet uptake,mucinous carcinoma

References

1. Rigo P, Paulus P, Kaschten BJ, et al. Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose. Eur J Nucl Med 1996 ;23:1641–1674
2. Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: Correlation of FDG uptake with histopathologic features. Am J Roentgenol. 2000;174(4):1005-1008. doi:10.2214/ajr.174.4.1741005
3. Cohen AM, Minsky BD, Schilsky RL. Colon can- cer. In: Devita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: principles and practice of oncology, 4th ed. Philadelphia: Lippincott, 1993 :776–817
4. Flavell RR, Naeger DM, Aparici CM, Hawkins RA, Pampaloni MH, Behr SC. Malignancies with low fluoro-deoxyglucose uptake at PET/CT: Pitfalls and prognostic importance. Radiographics. 2016;36(1):293-294. doi:10.1148/rg.2016150073
5. Kim JP, Kim SC, Yang HK. Prognostic significance of signet ring cell carcinoma of the stomach. Surg Oncol. 1994;3(4):221-227. doi:10.1016/0960-7404(94)90037-X
6. Green JB, Timmcke AE, Mithcel WT, Hicks TC, Gathright JB Jr, Ray JE. Mucinous carcinoma— just another colon cancer? Dis Colon Rectum 1993 ;36:49–54
7. Fujita K, Sugao H, Gotoh T, Yokomizo S, Itoh Y. Primary signet ring cell carcinoma of the prostate: report and review of 42 cases. Int J Urol. 2004 Mar;11(3):178–81.
8. Bamboat ZM, Tang LH, Vinuela E, et al. Stage-stratified prognosis of signet ring cell histology in patients undergoing curative resection for gastric adenocarcinoma. Ann Surg Oncol. 2014;21(5):1678-1685. doi:10.1245/s10434-013-3466-8

9. Ren J, Niu G, Wang X, Song T, Hu Z, Ke C. Effect of age on prognosis of gastric signet-ring cell carcinoma: A SEER database analysis. Med Sci Monit. 2018;24:8524-8532. doi:10.12659/MSM.911766
10. Voron T, Messager M, Duhamel A et al: Is signet-ring cell carcinoma a specific entity among gastric cancers? Gastric Cancer, 2016; 19: 1027–40
11. Shim JH, Song KY, Kim HH et al: Signet ring cell histology is not an independent predictor of poor prognosis after curative resection for gastric cancer: A propensity analysis by the klass group. Medicine, 2014; 93: e136
12. Maehara Y, Sakaguchi Y, Moriguchi S, Orita H, Korenaga D, Kohnoe K. Signet ring cell carcinoma of the stomach. Cancer 1992; 69: 1645-50.
13. Stahl A, Ott K, Weber WA, et al. FDG PET imaging of locally advanced gastric carcinomas: Correlation with endoscopic and histopathological findings. Eur J Nucl Med Mol Imaging. 2003;30(2):288-295. doi:10.1007/s00259-002-1029-5
14. Baldus SE, Zirbes TK, Engel S, et al. Correlation of the immunohistochemical reactivity of mucin peptide cores MUC1 and MUC2 with the histopathological subtype and prognosis of gastric carcinomas. Int J Cancer. 1998;79(2):133-138. doi:10.1002/(SICI)1097-0215(19980417)79:2<133::AID-IJC6>3.0.CO;2-U
15. Kim, JP, Kim, SC, Yang, HK Prognostic significance of signet ring cell carcinoma of the stomach. Surgical Oncology 1994; 3(4), 221–227. doi:10.1016/0960-7404(94)90037-X