Ces radiol. 2025, 79(1):52-56 | DOI: 10.55095/CesRadiol2025/007

Quadruple primary cancer of the colon, prostate and trachea incidentally diagnosed by 18F-FDG PET/CT imaging in patient with positive history of bronchioalveolar carcinomaCase report

Jiří Doležal1, Dana Dvořáková2, Lucie Turková3
1 Oddělení nukleární medicíny, Fakultní nemocnice Hradec Králové a Lékařská fakulta v Hradci Králové, Univerzita Karlova, Praha
2 Multiscan Pardubice
3 Radiologická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta v Hradci Králové, Univerzita Karlova, Praha

Aim: A rare case of incidental detection of quadruple primary cancer (colon, prostate and trachea) by means of 18F-FDG PET/CT in a 74-year-old man with positive history of bronchioalveolar carcinoma.

Method: PET/CT scan was performed in 60 minutes after intravenous administration of 18F-FDG with activity of 4.5 MBq/kg. Monophasic contrast-enhanced CT imaging was performed in identical extent. Acquisition of CT imaging data was targeted to the venous circulation.

Results: A focus of increased 18F-FDG uptake in the left neck lymph node and the distal part of the trachea, as well as eccentric thickening of the wall of the sigmoid colon with 18F-FDG uptake and a focus of increased 18F-FDG uptake in the periphery of the right lobe of the prostate were detected. The finding was evaluated as a viable metastasis to the neck and distal trachea and highly suspicious for a synchronous tumour of the sigmoid colon and prostate. Bronchoscopy with biopsy showed squamous cell carcinoma in the trachea. The patient also underwent colonoscopy and biopsy, which confirmed the presence of adenocarcinoma in the colon. Abdomen surgery revealed locally advanced, inoperable tumour and a colostomy was established. Serum PSA levels were found to be increased (6.5 µg/l; normal 0-4 µg/l) and biopsy confirmed the presence of prostate cancer. Due to the patient's clinical condition and wishes, curative therapy was then discontinued, and only palliative symptomatic treatment was continued.

Conclusion: The 18F-FDG PET/CT scan correctly detected tumour quadruple (colon, prostate, trachea) in a patient with a positive history of bronchioalveolar carcinoma, which completely changed the prognosis of the patient and essentially the treatment strategy. Furthermore, PET/CT scanning significantly reduced the diagnostic process time.

Keywords: 18F-FDG, PET, CT, synchronous multiple primary cancers.

Accepted: January 31, 2025; Published: April 22, 2025  Show citation

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Doležal J, Dvořáková D, Turková L. Quadruple primary cancer of the colon, prostate and trachea incidentally diagnosed by 18F-FDG PET/CT imaging in patient with positive history of bronchioalveolar carcinoma. Ces radiol. 2025;79(1):52-56. doi: 10.55095/CesRadiol2025/007.
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