Colorectal Cancer - 70 year old male

Case Description:
Patient with a history of colorectal cancer with rising CEA level.

Clinical History
A 70 year old man with a history of colorectal cancer, status post resection, with rising CEA level was scheduled for a restaging PET•CT scan.

Imaging Findings


The PET•CT scan revealed a focal area of intense increased uptake of FDG in the presacral space corresponding to small presacral node or soft tissue mass in that area on the CT portion of the exam. This area of increased uptake was very suspicious for recurrent malignancy.

Pathology Report
A CT guided biopsy of the presacral mass was positive for malignant cells, and confirmed moderately differentiated adenocarcinoma, consistent with metastasis from colonic primary.

Treatment and Follow-up
The patient underwent chemotherapy followed by resection of presacral mass.

Discussion
The PET•CT scan was helpful in guiding the biopsy the patient's right sided presacral lesion, which yielded the diagnosis of recurrent adenocarcinoma. This was also a nice case of detecting an abnormality when the patient's tumor markers began to rise. Although this abnormality likely would have been picked up on CT alone, often times in this patient population we will find occult metastases.

Data courtesy of Dr. Todd Blodgett, University of Pittsburg Medical Center, Pittsburgh, Pennsylvania

*Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.