Recurrencia de un carcinoma gástrico de células en anillo de sello demostrada por PET-FDG

• Published in: Revista española de medicina nuclear Vol. 24; no. 5; pp. 326 - 330
• Main Authors: Ruiz-Hernández, G., Delgado-Bolton, R.C., Rubio-Pérez, M.J., Jiménez-Vicioso, A., Pérez-Castejón, M.J., Carreras-Delgado, J.L.
• Format: Journal Article
• Language: Spanish
• Published: Elsevier Espana 2005
• Subjects: Cáncer gástrico; Células en anillo de sello; FDG-PET; Gastric cancer; Non-intestinal or mucinous tumors; PET-FDG; Signet ring cell carcinomas; Tumores no intestinales o mucinosos; FDG-PET; Signet ring cell carcinomas; Tumores no intestinales o mucinosos; Non-intestinal or mucinous tumors; PET-FDG; Gastric cancer; Células en anillo de sello; Cáncer gástrico
• ISSN: 0212-6982; 1578-200X
• DOI: 10.1157/13079285

Presentar la detección de una recurrencia secundaria a un carcinoma gástrico difuso, con células en anillo de sello e indiferenciado mediante PET-FDG. Se trataba de un paciente con estadio III diagnosticado en 1994 y tratado con gastrectomía subtotal. En febrero del 2003 se diagnostica recurrencia mediastínica y supraclavicular izquierda, administrándose quimioterapia y radioterapia alcanzando respuesta completa. Tras 6 meses libre de enfermedad, presenta una elevación de marcadores tumorales con pruebas complementarias (endoscopia digestive alta, gammagrafía ósea y TC) negativas, efectuándose PET-FDG para descartar recurrencia. La PET-FDG identificó lesiones probablemente malignas en región supraclavicular derecha y en mediastino, confirmándose dichos hallazgos por seguimiento clínico y la realización de una TC 4 meses más tarde. Destacamos la detección de recurrencia precoz por PET-FDG en un carcinoma no intestinal gástrico, circunstancia que creemos de interés dada la mayor dificultad de la PET-FDG en la detección de carcinomas productores y/o secretores de moco. To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease. The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease. FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later. In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG.