Focal Immunotherapy-Induced Pancreatitis Mimicking Metastasis on FDG PET/CT

Clin Nucl Med. 2019 Oct;44(10):836-837. doi: 10.1097/RLU.0000000000002692.

Abstract

A 46-year-old man with metastatic lung adenocarcinoma was treated with pembrolizumab. FDG PET/CT was performed after 3 cycles of treatment and revealed a focal region of pancreatic tail enlargement with an SUVmax value of 7. Following treatment with corticosteroids and discontinuation of pembrolizumab, radiological resolution was observed, and a diagnosis of focal immunotherapy-induced pancreatitis was made. A unique spectrum of FDG-avid adverse events can develop in patients treated with immune-checkpoint inhibitors that may mimic metastatic disease. Knowledge of the radiologic features of these potential imaging pitfalls is crucial among those interpreting FDG PET/CT to allow prompt and decisive treatment.

Publication types

  • Case Reports

MeSH terms

  • Adenocarcinoma of Lung / diagnostic imaging
  • Adenocarcinoma of Lung / drug therapy
  • Adenocarcinoma of Lung / pathology
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Diagnosis, Differential
  • Fluorodeoxyglucose F18*
  • Humans
  • Immunotherapy / adverse effects*
  • Male
  • Middle Aged
  • Pancreatitis / diagnostic imaging*
  • Pancreatitis / etiology*
  • Positron Emission Tomography Computed Tomography*

Substances

  • Antibodies, Monoclonal, Humanized
  • Fluorodeoxyglucose F18
  • pembrolizumab