INTERESTING IMAGE
Solitary Splenic Metastasis From Hepatocellular Carcinoma Detected on 18F-FDG PET/CT Do-Hoon Kim, MD, Shin Young Jeong, MD, PhD, Sang-Woo Lee, MD, PhD, Jaetae Lee, MD, PhD, and Byeong-Cheol Ahn, MD, PhD Abstract: We report a case of solitary splenic metastasis from hepatocellular carcinoma detected on 18F-FDG PET/CT. A 67-year-old man with hepatocellular carcinoma was referred for 18F-FDG PET/CT to determine the cause of his elevated serum α-fetoprotein levels after liver segmentectomy and radio-frequency ablation. 18F-FDG PET/CT imaging showed focal FDG uptake in the spleen, with no other abnormal findings. A splenectomy was performed, and histopathologic examination confirmed the lesion as a metastasis from the hepatocellular carcinoma. Key Words: splenic metastasis, hepatocellular carcinoma, 18F-FDG PET/CT (Clin Nucl Med 2015;40: e325–e327) Received for publication July 24, 2014; revision accepted October 27, 2014. From the Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea. Conflicts of interest and sources of funding: Supported by a grant from the Medical Cluster R&D Support Project of Daegu Gyeongbuk Medical Innovation Foundation, Republic of Korea (2013); a grant (A111345) from the Korea Health Technology R&D Project, Ministry of Health andWelfare, Republic of Korea; a grant fromthe National Nuclear R&D Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology (no. 2012M2A2A7014020); and a grant from the National Research Foundation of Korea funded by the Korea government (Ministry of Education, Science, and Technology) (No. 2009-0078222, 2009-0078234). Reprints: Byeong-Cheol Ahn, MD, PhD, Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung Gu, Daegu, 700–721, Republic of Korea. E-mail: [email protected]. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4006–e325
ACKNOWLEDGMENTS The authors would like to thank Dr Gil Sook Yoon (Kyungpook National University School of Medicine) for preparing the histopathologic images. REFERENCES 1. Clark HP, Carson WF, Kavanagh PV, et al. Staging and current treatment of hepatocellular carcinoma. Radiographics. 2005;25:S3–S23. 2. Katyal S, Oliver JH 3rd, Peterson MS, et al. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703. 3. Becker AK, Tso DK, Harris AC, et al. Extrahepatic metastases of hepatocellular carcinoma: a spectrum of imaging findings. Can Assoc Radiol J. 2014;65:60–66. 4. Comperat E, Bardier-Dupas A, Camparo P, et al. Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med. 2007;131:965–969. 5. Alkım H, Alkım C, Şaşmaz N, et al. Solitary splenic metastasis from hepatocellular carcinoma. Med J Bakırköy. 2011;7:164–166. 6. An YS, Yoon JK, Hong SP, et al. Isolated splenic metastasis of sigmoid colon cancer detected by 18F-FDG PET/CT. Nucl Med Mol Imaging. 2007;41:263–264. 7. Schon CA, Gorg C, Ramaswamy A, et al. Splenic metastases in a large unselected autopsy series. Pathol Res Pract. 2006;202:351–356. 8. Lee DH, Yoon JK, Lee SJ, et al. Isolated splenic metastasis of ovarian cancer detected with 18F-FDG PET/CT. Clin Nucl Med. 2014;39:349–351.
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
e325
Kim et al
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015
FIGURE 1. A 67-year-old man had undergone liver segmentectomy and radio-frequency ablation for hepatocellular carcinoma (HCC) and had been in disease-free status. After 78 months, the serum α-fetoprotein level was elevated up to 422.6 ng/mL (reference range,
Solitary Splenic Metastasis From Hepatocellular Carcinoma Detected on 18F-FDG PET/CT Do-Hoon Kim, MD, Shin Young Jeong, MD, PhD, Sang-Woo Lee, MD, PhD, Jaetae Lee, MD, PhD, and Byeong-Cheol Ahn, MD, PhD Abstract: We report a case of solitary splenic metastasis from hepatocellular carcinoma detected on 18F-FDG PET/CT. A 67-year-old man with hepatocellular carcinoma was referred for 18F-FDG PET/CT to determine the cause of his elevated serum α-fetoprotein levels after liver segmentectomy and radio-frequency ablation. 18F-FDG PET/CT imaging showed focal FDG uptake in the spleen, with no other abnormal findings. A splenectomy was performed, and histopathologic examination confirmed the lesion as a metastasis from the hepatocellular carcinoma. Key Words: splenic metastasis, hepatocellular carcinoma, 18F-FDG PET/CT (Clin Nucl Med 2015;40: e325–e327) Received for publication July 24, 2014; revision accepted October 27, 2014. From the Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea. Conflicts of interest and sources of funding: Supported by a grant from the Medical Cluster R&D Support Project of Daegu Gyeongbuk Medical Innovation Foundation, Republic of Korea (2013); a grant (A111345) from the Korea Health Technology R&D Project, Ministry of Health andWelfare, Republic of Korea; a grant fromthe National Nuclear R&D Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology (no. 2012M2A2A7014020); and a grant from the National Research Foundation of Korea funded by the Korea government (Ministry of Education, Science, and Technology) (No. 2009-0078222, 2009-0078234). Reprints: Byeong-Cheol Ahn, MD, PhD, Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50, Samduk 2-ga, Jung Gu, Daegu, 700–721, Republic of Korea. E-mail: [email protected]. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4006–e325
ACKNOWLEDGMENTS The authors would like to thank Dr Gil Sook Yoon (Kyungpook National University School of Medicine) for preparing the histopathologic images. REFERENCES 1. Clark HP, Carson WF, Kavanagh PV, et al. Staging and current treatment of hepatocellular carcinoma. Radiographics. 2005;25:S3–S23. 2. Katyal S, Oliver JH 3rd, Peterson MS, et al. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703. 3. Becker AK, Tso DK, Harris AC, et al. Extrahepatic metastases of hepatocellular carcinoma: a spectrum of imaging findings. Can Assoc Radiol J. 2014;65:60–66. 4. Comperat E, Bardier-Dupas A, Camparo P, et al. Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis. Arch Pathol Lab Med. 2007;131:965–969. 5. Alkım H, Alkım C, Şaşmaz N, et al. Solitary splenic metastasis from hepatocellular carcinoma. Med J Bakırköy. 2011;7:164–166. 6. An YS, Yoon JK, Hong SP, et al. Isolated splenic metastasis of sigmoid colon cancer detected by 18F-FDG PET/CT. Nucl Med Mol Imaging. 2007;41:263–264. 7. Schon CA, Gorg C, Ramaswamy A, et al. Splenic metastases in a large unselected autopsy series. Pathol Res Pract. 2006;202:351–356. 8. Lee DH, Yoon JK, Lee SJ, et al. Isolated splenic metastasis of ovarian cancer detected with 18F-FDG PET/CT. Clin Nucl Med. 2014;39:349–351.
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
e325
Kim et al
Clinical Nuclear Medicine • Volume 40, Number 6, June 2015
FIGURE 1. A 67-year-old man had undergone liver segmentectomy and radio-frequency ablation for hepatocellular carcinoma (HCC) and had been in disease-free status. After 78 months, the serum α-fetoprotein level was elevated up to 422.6 ng/mL (reference range,
