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Nonspecific FDG uptake in the tongue mimicking the primary tumor in a patient with cancer of unknown primary

  • Matthias K. Werner
    Correspondence
    Corresponding author. Eberhard-Karls-University Medical Center, Department of Diagnostic and Interventional Radiology, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany. Tel.: +49 7071 29 86677; fax: +49 7071 29 4501.
    Affiliations
    Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Medical Center Tübingen, Germany
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  • Christina Pfannenberg
    Affiliations
    Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Medical Center Tübingen, Germany
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  • Mehmet Ö. Öksüz
    Affiliations
    Department of Nuclear Medicine, Eberhard-Karls-University Medical Center Tübingen, Germany

    Institute of Diagnostic Radiology, University Hospital Basel, Switzerland
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Published:November 15, 2010DOI:https://doi.org/10.1016/j.clinimag.2010.09.005

      Abstract

      For cancers of the head and neck, the combination of 18F-fluorodeoxy-glucose positron emission tomography (FDG-PET)/computed tomography (CT) gains wide acceptance, especially if the primary tumor is unknown (CUP).
      A patient underwent FDG-PET/CT for squamous cell CUP with cervical lymph node metastases. FDG-PET/CT showed uptake in the right side of the tongue, rendering this area a possible location for the primary tumor. However, clinical examination revealed a deviation of the tongue toward the left side indicating affection of the left hypoglossal nerve, causing the increased FDG uptake.
      This case illustrates the interpretive pitfalls of unspecific FDG uptake in PET/CT imaging of the head and neck.

      Keywords

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      References

        • Rodrigues RS
        • Bozza FA
        • Christian PE
        • Hoffman JM
        • Butterfield RI
        • Christensen CR
        • Heilbrun M
        • Wiggins RH
        • Hunt JP
        • Bentz BG
        • Hitchcock YJ
        • Morton KA
        Comparison of whole-body PET/CT, dedicated high-resolution head and neck PET/CT, and contrast-enhanced CT in preoperative staging of clinically M0 squamous cell carcinoma of the head and neck.
        J Nucl Med. 2009; 50: 1205-1213
        • Cianchetti M
        • Mancuso AA
        • Amdur RJ
        • Werning JW
        • Kirwan J
        • Morris CG
        • Mendenhall WM
        Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site.
        Laryngoscope. 2009; 119: 2348-2354
        • Blodgett TM
        • Fukui MB
        • Snyderman CH
        • Branstetter BF
        • McCook BM
        • Townsend DW
        • Meltzer CC
        Combined PET-CT in the head and neck: part 1. Physiologic, altered physiologic, and artifactual FDG uptake.
        Radiographics. 2005; 25: 897-912
        • Fukui MB
        • Blodgett TM
        • Snyderman CH
        • Johnson JJ
        • Myers EN
        • Townsend DW
        • Meltzer CC
        Combined PET-CT in the head and neck: part 2. Diagnostic uses and pitfalls of oncologic imaging.
        Radiographics. 2005; 25: 913-930
        • Ferda J
        • Ferdová E
        • Záhlava J
        • Walter J
        • Mukenšnabl P
        • Daum O
        • Kreuzberg B
        (18)F-FDG-PET/CT of orofacial tumors, a value of whole-body imaging approach.
        Eur J Radiol. 2010; 73: 241-248
        • Gorospe L
        • Raman S
        • Echeveste J
        • Avril N
        • Herrero Y
        • Herna Ndez S
        Whole-body PET/CT: spectrum of physiological variants, artifacts and interpretative pitfalls in cancer patients.
        Nucl Med Commun. 2005; 26: 671-687
        • Lin HC
        • Barkhaus PE
        Cranial nerve XII: the hypoglossal nerve.
        Semin Neurol. 2009; 29: 45-52
        • Thompson EO
        • Smoker WRK
        Hypoglossal nerve palsy: a segmental approach.
        Radiographics. 1994; 14: 939-958