Detection of primary and metastatic lesions by [18F]fluoro-2-deoxy-D-glucose PET in a patient with thymic carcinoid

A 76-year-old man with COPD presented to a commu-nity hospital complaining of dysphasia and hoarse-ness for 3 months. A chest radiograph revealedoverinflation, elevated left diaphragm, mediastinalwidening and deviation of the trachea to the right.Chest CT and MRI demonstrated a heterogeneouslyenhanced bulky mass (10 ¥ 8 ¥ 6 cm) in the anteriormediastinum (Fig. 1). Under CT guidance, needleaspiration biopsy was performed, and a diagnosis oftypical carcinoid of thymic origin was made. Immu-nohistochemial studies on the specimen showedpositive results for cytokeratin, synaptophysin,chromogranin, CD56 and neuron-specific enolase(Fig. 2), and negative results for somatostatin recep-tor, serotonin, adrenocorticotropic hormone andgastrin (data not shown). The patient was referred toour hospital for treatment.Physical examination was unremarkable except fordysphasia. No lymphadenopathy was found on thesurface of the body, although the left supraclavicularlymph node was slightly swollen on chest CT. Symp-toms of carcinoid syndrome were not observed. Bloodchemistry results were normal, and serum serotoninand urinary excretion of 5-hydroxyindoleacetic acidwere unremarkable. Whole-body