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What Do These Following PET CT Scan, FNAC And Biopsy Reports Indicate?
Question: Hi,
My mother under went USG abdomen examination due to pain and the report shown multiple >10 para aortic enlarged lymph nodes 8-10 mm and suggested further evaluation to rule out lymphoma.
We consulted an oncologist and as suggested underwent whole body FT-18 PET CT and CT guided FNAC. PET CT report shown FDG intake and multiple hyper metabolic enlarged lymph nodes. (report attached)
Cytology report from FNAC mentioned as No malignant cells seen and possibility of tuberculosis may be considered (report attached)
Does identifying masses with FDG intake in PET CT always indicate cancer? The indication from FNAC report is giving hope but the PET findings are worrying us. Can TB cause FDG intake at multiple locations.
Based on findings in attached reports, what further investigations / specialist consultation is suggested.
My mother under went USG abdomen examination due to pain and the report shown multiple >10 para aortic enlarged lymph nodes 8-10 mm and suggested further evaluation to rule out lymphoma.
We consulted an oncologist and as suggested underwent whole body FT-18 PET CT and CT guided FNAC. PET CT report shown FDG intake and multiple hyper metabolic enlarged lymph nodes. (report attached)
Cytology report from FNAC mentioned as No malignant cells seen and possibility of tuberculosis may be considered (report attached)
Does identifying masses with FDG intake in PET CT always indicate cancer? The indication from FNAC report is giving hope but the PET findings are worrying us. Can TB cause FDG intake at multiple locations.
Based on findings in attached reports, what further investigations / specialist consultation is suggested.
Brief Answer:
May be tuberculosis too
Detailed Answer:
Hi
Thanks for your query.
From the PET report, lymphoma is the first possibility. FNAC may not pick up lymphoma always, so I would not take that report as completely ruling out lymphoma. Tuberculosis can also cause this type of PET picture but a 4 cm lymph node mass is bit odd for tuberculosis.
I would strongly recommend a biopsy, either CT guided needle biopsy or laparoscopic biopsy from the larger node. Along with that tests for tuberculosis may be carried out.
Hope this helps.
Regards
May be tuberculosis too
Detailed Answer:
Hi
Thanks for your query.
From the PET report, lymphoma is the first possibility. FNAC may not pick up lymphoma always, so I would not take that report as completely ruling out lymphoma. Tuberculosis can also cause this type of PET picture but a 4 cm lymph node mass is bit odd for tuberculosis.
I would strongly recommend a biopsy, either CT guided needle biopsy or laparoscopic biopsy from the larger node. Along with that tests for tuberculosis may be carried out.
Hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Thank you very much for the response.
We did blood test for LDH was found to be normal. Calcium too within range, though towards higher side of range.
Mantoux test is also performed, more than 48 hrs before. There is a small red colour on skin but our doctor feels it doesnt appear to be like in case of TB. Could be a wrong Mantoux administration as there was bleeding at the time of injection, may be the tuberculin injected also lost in blood.
Would you suggest any specific test for tuberculosis ? We have an appointment with oncologist tomorrow, to show the PET CT and FNAC reports.
Regards,
XXXX
We did blood test for LDH was found to be normal. Calcium too within range, though towards higher side of range.
Mantoux test is also performed, more than 48 hrs before. There is a small red colour on skin but our doctor feels it doesnt appear to be like in case of TB. Could be a wrong Mantoux administration as there was bleeding at the time of injection, may be the tuberculin injected also lost in blood.
Would you suggest any specific test for tuberculosis ? We have an appointment with oncologist tomorrow, to show the PET CT and FNAC reports.
Regards,
XXXX
Brief Answer:
let's see the oncologist's views
Detailed Answer:
You can discuss about quantiferon Tb gold and sputum testing for TB. But most importantly a biopsy will be required.
Wrong Mantoux administration do occur but it is not possible to guess it just from the bleeding.
let's see the oncologist's views
Detailed Answer:
You can discuss about quantiferon Tb gold and sputum testing for TB. But most importantly a biopsy will be required.
Wrong Mantoux administration do occur but it is not possible to guess it just from the bleeding.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
We consulted oncologist, Doctor observed the Mantoux administered area mentioned it looks positive. As per his suggestion we USG evaluation of neck and also performed Trucut biopsy from the para aortic lymph node, which seemed to be the largest in PET scan.
The biopsy report (attached) says chronic granulomatous inflammation. It mentions that no acid fast bacilli is seen and suggest to consider possibility of TB.
The PET report shows FDG intake but the FNAC, Biopsy report seems to be suggesting no malignant cells.
Based on these can we think not to worry about Lymphoma/any other cancer or do you suggest any further investigations to completely rule out possibility of cancer?
The biopsy report (attached) says chronic granulomatous inflammation. It mentions that no acid fast bacilli is seen and suggest to consider possibility of TB.
The PET report shows FDG intake but the FNAC, Biopsy report seems to be suggesting no malignant cells.
Based on these can we think not to worry about Lymphoma/any other cancer or do you suggest any further investigations to completely rule out possibility of cancer?
Brief Answer:
The biopsy can be reviewed
Detailed Answer:
This biopsy report all but excludes lymphoma. However, it may be prudent to get it reviewed by some expert pathologist.
The biopsy can be reviewed
Detailed Answer:
This biopsy report all but excludes lymphoma. However, it may be prudent to get it reviewed by some expert pathologist.
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Above answer was peer-reviewed by :
Dr. Prasad
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