case_images: PMC5824325_01
case_images: MRI and 18F-DG-PET scan.. (
  A) In October 2014, several metastasis at D6-D7, right acetabulum (3cm); vertebral hemi-body D10 (3cm); vertebral body of D12 (2cm); and left iliac crest (1cm) were observed. (
  B) 4 months later, a PET-TAC showed a metabolic stabilization of the disease, but with a slight growth of lesions according to MRI. (
  C) During the following 11 months, the patient remained stable without disease progression. (
  D) In May 2016, a 18 FDG-PET-TAC revealed an important metastatic dissemination all over the skeleton, showing more than 40 small new lesions (<2 cm), and with scarce or null Octreoscan and
  123I-MIBG uptake. (
  E) In December 2016, most of lesions had disappeared according to PET-TAC. (
  F) In July 2017, a new PET supported the previous results, showing the remaining two lesions but with maximum SUV lower. (
  G) In October 2017, 4 months since the last dose of temozolomide, and propranolol as the only treatment (240mg/day), the disease remains controlled according to this last PET-TAC.
case_images: f1000research-6-14305-g0000.jpg
case_images: PMC5824325_01_f1000research-6-14305-g0000.jpg
case_images: f1
case_images: D10 lesion biopsy confirmed the diagnosis of PGL metastasis with a Ki67 around 15-20% ( Figure 1A). After 4 months, a PET-TAC showed a metabolic stabilization of the disease, but with a slight growth of lesions according to MRI ( Figure 1B). During the following 11 months, the patient remained stable without disease progression ( Figure 1C). A, 106 ng/mL (normal level, <93); urine fractionated Norepinephrine, 196 mcg/24h (normal levels, 15-80); urine fractionated normetanephrine, 1316 mcg/24 h (normal levels, 128-484); urine total metanephephrine, 1394 mcg/24h (normal levels, 220-680). A 18FDG-PET-TAC revealed an important metastatic dissemination all over the skeleton, showing more than 40 small new lesions less than 2 cm, and with scarce or null Octreoscan and 123I-MIBG uptake ( Figure 1D). In December 2016, most of lesions had disappeared according to PET-TAC ( Figure 1E). In July 2017, a new PET supported the previous results, showing the remaining two lesions but with maximum SUV lower ( Figure 1F). In October 2017, 4 months since the last dose of temozolomide, and propranolol as the only treatment (240mg/day), the disease remains controlled according to the last PET-TAC (F18-FDG) ( Figure 1G).