A Case Study where CoDe PET/CT and Nuclear Medicine were Instrumental in the Staging and Treatment of Rhabdomyosarcoma
This is a case study of a 15 year old boy with a Rhabdomyosarcoma. He was sent to our department for a CoDe PET/CT to stage his cancer prior to extensive surgery. Several weeks later David developed surgical complications and required a Nuclear Medicine CSF scan before the surgeons could operate to repack the leaking site.
David first presented with a lump over the angle of the jaw. Ultrasound showed this to be a soft tissue lesion. 2 months later it was diagnosed as a probable Alveolar Rhabdomyosarcoma. A CoDe PET/CT performed in our department on the GE Infina VC Hawkeye showed moderate uptake in the lesion with no evidence of metastases. David went on to receive 7 cycles of chemotherapy and high dose radiotherapy prior to complex transcranial surgery 5 months later removing an Embryonal Rhabdomyosarcoma.
However 2 months later he had several episodes of collapse and developed rhinorrhea from the right nostril which showed +ve β transferrin confirming a CSF leak.
David returned to our department for a CSF SPECT/CT scan on the GE Infinia VC Hawkeye combined with a high resolution CT scan which dynamically confirmed the site of the leak.
David went back to surgery and was repacked successfully and is currently at home starting school again.
This case study shows how the CoDe PET/CT staged the Rhabdomyosarcoma as primary disease which lead to complex surgery confirming the negative nodal status but also highlights the importance of the dynamic CSF imaging giving the neurosurgeons the confidence to operate and repack at the site shown on our SPECT/CT scan.