Gastric Ulcer Mimicking Malignancy on FDG PET/CT

Area of Science:

• Oncology
• Nuclear Medicine
• Gastroenterology

Background:

• Cervical cancer staging often involves F-FDG PET/CT to assess disease extent and lymph node involvement.
• Fluorine-18 fluorodeoxyglucose (F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) is a key imaging modality in oncologic staging.
• Gastric lesions can present with variable F-FDG uptake, sometimes mimicking malignancy.

Observation:

• A 52-year-old woman with newly diagnosed cervical carcinoma underwent F-FDG PET/CT for staging.
• The PET/CT demonstrated known cervical carcinoma and enlarged, hypermetabolic lymph nodes.
• An additional focus of intense F-FDG activity was noted in the gastric antrum.

Findings:

• The hypermetabolic gastric antrum lesion was biopsied and confirmed as a gastric ulcer.
• The patient's cervical cancer was staged appropriately, with incidental identification of the gastric pathology.
• The gastric ulcer responded successfully to antiulcer treatment.

Implications:

• F-FDG PET/CT can identify unexpected findings outside the primary cancer site, requiring careful interpretation.
• Hypermetabolic activity in the stomach on F-FDG PET/CT does not always indicate malignancy; benign conditions like ulcers can show increased uptake.
• This case highlights the importance of integrating imaging findings with clinical information and biopsy results for accurate diagnosis and management.