CLINICAL NUCLEAR MEDICINE Volume 28, Number 6, pp 489 –491 © 2003, Lippincott Williams & Wilkins, Inc. Differentiation of Synchronous Tumors Using FDG Positron Emission Tomography MARK D. WILKINSON, M.B.CH.B.,* MICHAEL J. FULHAM, F.R.A.C.P.,*‡ BRIAN C. MCCAUGHAN, F.R.A.C.S.,† AND CHRIS J. CONSTABLE, B.APP.SC.* The authors describe a 65-year-old man with a 50 pack- year smoking history who was examined by his local physician for incidental right-sided chest wall pain. A chest radiograph showed a mass in the left lung sug- gestive of a neoplastic lesion. During investigations to stage the lung lesion, a large pancreatic mass, celiac nodal enlargement, and multiple hepatic lesions consis- tent with metastases were found. Fine-needle aspirates showed that the lung lesion was a non–small-cell lung carcinoma (NSCLC), which histologic analysis showed to be poorly differentiated squamous cell carcinoma. In addition, a well-differentiated endocrine tumor was found in the pancreas and celiac nodes. The reduced glucose avidity seen in the pancreatic, celiac, and liver lesions on F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET), compared with the marked FDG uptake seen in the primary lung lesion, suggested that the liver lesions were most likely metastatic from the pancreatic tumor rather than the NSCLC. Conse- quently, a liver biopsy was deemed unnecessary and the patient underwent surgical resection for attempted cure of the NSCLC. Key Words: F-18 Fluorodeoxyglucose, Non–Small-Cell Lung Cancer, Pancreatic Endocrine Tumor, Positron Emission Tomography, Squamous Cell Carcinoma. References 1. Pasquali C, Rubello D, Sperti C, et al: Neuroendocrine tumor imaging: Can 18 F-fluorodeoxyglucose positron emission tomog- raphy detect tumors with poor prognosis and aggressive behav- iour? World J Surg 22:588, 1998. 2. Adams S, Baum R, Rink T, et al: Limited value of fluorine-18 fluorodeoxyglucose positron emission tomography for the im- aging of neuroendocrine tumours. Eur J Nucl Med 25:79, 1998. 3. Eriksson B, Bergstrom M, Orlefors H, et al: Use of PET in neu- roendocrine tumors. In vivo applications and in vitro studies. Q J Nucl Med 44:68, 2000. 4. Bombardieri E, Maccauro M, Castellani MR, et al: Radioisotopic imaging of neuroendocrine tumours. Which radiopharmaceuti- cal and which diagnostic procedure? Minerva Endocrinol 26: 197, 2001. 5. Eriksson B, Bergstrom M, Lilja A, et al: Positron emission tomog- raphy (PET) in neuroendocrine gastrointestinal tumors. Acta Oncol 32:189, 1993. 6. Ahlstrom H, Eriksson B, Bergstrom M, et al: Pancreatic neuroen- docrine tumors: diagnosis with PET. Radiology 195:320, 1995. 7. Rigo P, Paulus P, Kaschten BJ, et al: Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglu- cose. Eur J Nucl Med 23:1641, 1996. Received for publication June 5, 2002. Revision accepted December 9, 2002. Correspondence: M. J. Fulham, Department of PET and Nuclear Medicine, Building 63, Level A7, Royal Prince Alfred Hospital, Camp- erdown 2050, Sydney, New South Wales, Australia. E-mail: mfulham@med.usyd.edu.au From the Departments of PET and Nuclear Medicine* and Cardiothoracic Surgery,† Royal Prince Alfred Hospital, Camperdown, and the Department of Medicine,‡ University of Sydney, Sydney, New South Wales, Australia 489