case_images: PMC11609104_01
case_images: Selected transaxial images from the initial FDG PET/CT and subsequent FES PET/CT in this patient with enlarging pulmonary nodule and prior ER+ breast cancer and pulmonary adenocarcinoma. Transaxial fused FDG PET/CT (1A) CT (1B) and FDG PET (1C) images show a right lower lobe pulmonary nodule with uptake comparable to blood pool with SUVmax 2.5 (yellow arrow). Transaxial fused FES PET/CT (1D) CT (1E) and FES PET (1F) images demonstrate avid uptake in the pulmonary nodule with SUVmax 3.0 (blue arrow). Coronal FES PET maximum intensity projection (MIP; 1G) demonstrates the FES avid pulmonary nodule which was biopsy proved pulmonary adenocarcinoma (blue arrow) and no other abnormal FES avid foci to suggest additional ER+ disease, either from lung or breast primary. Note intense physiological FES uptake in the liver and excretion through the biliary tree into the bowel (green arrow).
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case_images: A 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET) / computed tomography (CT) scan was obtained for aid in diagnosis and staging, and which demonstrated mildly increased FDG uptake in the pulmonary nodule comparable to blood pool (Fig. 1A) and no other potential sites of hypermetabolic disease. FES uptake in the pulmonary nodule would be selective and confirmatory for any potential estrogen receptor positive (ER+) breast cancer metastatic deposits, and thus allowing for proper staging and treatment. FES PET/CT demonstrated high level of FES uptake in the pulmonary nodule and was interpreted as ER+ breast metastatic pulmonary disease (Fig. 1D).
case_images: Histologic sections of the right lower lobe cryobiopsy demonstrate adenocarcinoma with acinar growth pattern (Fig. 2A) and with immunohistochemical analysis positive for TTF-1 (Fig. 2B) and negative for p40, GATA-3, and BRST-2, consistent with an adenocarcinoma of lung origin. In additional immunohistochemical studies, approximately 50% of the tumor cells exhibited weak positivity for estrogen receptor and progesterone receptor (Figs. 2C and 2D). Original magnification x630.
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case_images: As no other sites of disease were identified, the patient underwent endobronchial ultrasound guided biopsy of the pulmonary nodule for definitive diagnosis with histopathology findings consistent with pulmonary adenocarcinoma recurrence (Figs. 2A and B). Additional immunohistochemical studies demonstrated approximately 50% of the tumor cells exhibited weak positivity for ER and progesterone receptor (PR) (Figs. 2C and D).