Abstract
Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood. Despite clinical advances, subsets of these patients continue to suffer high morbidity and mortality rates associated with their disease. Following the European guidelines for 18F-FDG PET and PET-CT imaging in pediatric oncology, the routine use of 18F-FDG PET-CT may be useful for patients affected by rhabdomyosarcoma, in staging, in the evaluation of response to therapy, and for restaging/detection of relapse. The European Pediatric Protocols are very old, and for staging and restaging, they recommend only radionuclide bone scan. The 18F-FDG PET-CT exam is listed as an optional investigation prescribed according to local availability and local protocols in the investigations panel required at the end of the treatment. We present two cases highlighting the usefulness of 18F-FDG PET-CT in managing pediatric patients affected by rhabdomyosarcoma, providing some bibliographic references.
Highlights
CBhoetmhoethxearmapsywweirteh cVoPn1s6is(tEepnotswidiet)hwdaissease remissatsnaidortnsei.dx.DmTehosrnpetiehtems taohfnteethrgstohloaidsteerrxe,aasmufulitnrstahoteiforrnPeE(cfeT)n,-CtthTrea(PdeEi)oTs/h-cCohwTemewdoaatshmceoernatsapibsyot,elaincntpdwrocitgohrneassipsdiroeonrgirnaetgstshtihveeethdpoirrseaevcaiiscoeulewsvidethli,ffuse relapbsoendeisinevaoselv,elmowen-dt,olsyemmphainnotednesa,nacnedchluenmgos tmheertaasptayswis.itThhVe Pp1at6ie(nEtpdoiseidde2)5wmaosnsthtasrateftde.r Tthhereineimtiaol nths later,daiafgunrotshies.r PET-CT (e) showed a metabolic progression at the thoracic level, and six months after this examination (f), the PET-CT was consistent with a progressive disease with bone involvement, lymph nodes, and lungs metastasis
Diagnostics 2020, 10, 1112 the last nuclear medical investigation, following the suspicion of brain progression, confirmed by the contrast-enhanced CT, a new PET-CT was performed for a complete restaging
In the first one (Figure 1) of the two presented cases, the unexpected lymph-nodes metastatic involvement of the contralateral leg and the evidence of distance metastasis to the left gluteus maximus muscle, documented by 18F-FDG PET-CT, with the data of the evolution of the disease provided by PET exams, are the significant contributions to the management of the patient
Summary
CBhoetmhoethxearmapsywweirteh cVoPn1s6is(tEepnotswidiet)hwdaissease remissatsnaidortnsei.dx.DmTehosrnpetiehtems taohfnteethrgstohloaidsteerrxe,aasmufulitnrstahoteiforrnPeE(cfeT)n,-CtthTrea(PdeEi)oTs/h-cCohwTemewdoaatshmceoernatsapibsyot,elaincntpdwrocitgohrneassipsdiroeonrgirnaetgstshtihveeethdpoirrseaevcaiiscoeulewsvidethli,ffuse relapbsoendeisinevaoselv,elmowen-dt,olsyemmphainnotednesa,nacnedchluenmgos tmheertaasptayswis.itThhVe Pp1at6ie(nEtpdoiseidde2)5wmaosnsthtasrateftde.r Tthhereineimtiaol nths later,daiafgunrotshies.r PET-CT (e) showed a metabolic progression at the thoracic level, and six months after this examination (f), the PET-CT was consistent with a progressive disease with bone involvement, lymph nodes, and lungs metastasis. 4P.E6,Tt-oCgTethreesrults, with the presence of metabolically active lymph nodes and the involvement of distant sites, were i.e., aihnidgihcalytivmeeotaf bsoiglniciafilclaynatclytivloewperrimsuarrvyivtualmroatrews iatnhdawTeLrRe gcorenastiestretnhtawni4th.6,atnogaegtghreesrswiviethmtheteasptraetiscence of meotanbcoolloicgaicllayl adcitsievaesely[m11p–h13n].oTdhees asnpdectihmeeinnv(loalmvienmecetnotmoyf)dsihstoawnetdsitaens,awlveeroelainr drhicaabtdivoemoyfossiagrncoifimcaantly lower(AsRuMrvSiv) awlirthatechsraonmdoswomerael ctorannssilsotceantitownsitth(2a;1n3)ag(qg3r5e;qss1i4v),ewmheictahsrtaestuicltos nincotlhoegiecxaplrdesissieoanseof[1a1n–13].
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