Unusually Metastatic Pattern with Extensive Subcutaneous Metastases in F-FDG PET/CT in a Patient with Recurrent Cervical Cancer

Received 3/1/2007; revised 4/11/2007; accepted 4/17/2007. For correspondence or reprints contact: Tzu-Chen Yen, M.D., Ph.D., Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University. 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan. Tel: (886)3-3281200 ext. 2620, Fax: (886)3-2110052, E-mail: [email protected] A 45-year-old woman was a victim of squamous cell carcinoma of uterine cervix and had received concurrent chemo-radiation therapy (CCRT) as her primary definite treatment for FIGO stage IB2 disease. She was found to have enlarged lymph nodes at right neck and left supraclavicular area after a disease-free interval of 5 months. Whole body CT revealed multiple suspicious metastases in lung, adrenal glands, and the subcutaneous area at the left lower back in addition to the lymph nodes at right neck and left supraclavicular area. Therefore, she was referred to our positron emission tomography (PET) center for “metabolic biopsy” to further confirm the nature of these unusual lesions especially those in lung and adrenal glands. Extensively multiple F-FDG-avid lesions in the subcutaneous areas were observed during this examination. Subcutaneous recurrent lesions in cervical cancer after CCRT were uncommon, and most were adenocarcinoma. According to the literatures from PubMed, only one was reported in cervical cancer by PET. This was another case of recurrent cervical cancer found to have multiple subcutaneous nodules when undergoing PET/CT.