F-18 FDG PET findings in a port site recurrence after laparoscopic radical nephrectomy in a patient with renal cell carcinoma.

Abstract: Laparoscopic radical nephrectomy is considered as an alternative to open surgery for localized renal cell carcinoma (RCC). However following this procedure, metastases to the port site have been infrequently reported. We report the FDG PET scan findings in a case of port site recurrence after laparoscopic radical nephrectomy. A 56-year-old man presented with painless hematuria of 3 months duration. He was evaluated and found to have a large heterogeneously enhancing soft tissue density mass (8 × 6.9 × 5.9 cm) in the upper and medial segments of the left kidney on CT. In view of features suggestive of neoplastic etiology the patient underwent laparoscopic left radical nephrectomy. Histopothalogy of the primary was high-grade urothelial carcinoma arising from the renal pelvis and the disease was stage II (T2 N0 M0). After surgery the patient received external beam radiotherapy (EBRT) to the left renal bed to a total of 50 Gy in 25 fractions in 36 days. Thereafter the patient developed a 2 × 2 cm nodule in the anterior abdominal wall at the site of laparoscopic port. Wide excision of the same was done and the patient was referred for FDG PET scan to evaluate disease status. Histopathology of the abdominal wall nodule revealed metastatic deposits of the carcinoma cells in the soft tissue. F-18 FDG PET scan done after 370 MBq (10 mCi) of tracer injection revealed hypermetabolic foci in the liver and anterior abdominal wall suggestive of active disease. F-18 FDG PET seems to be a valuable tool to assess port site recurrence and to restage disease even after so called “curative” resection of the tumor. The rarity of port site recurrence with additional information of disease status provided by FDG-PET merits the use of this modality in post-treatment evaluation of these patients.