title: Advanced adenoma diagnosis with FDG PET in a visibly normal mucosa: a case report.
abstract: BACKGROUND
  An accurate, early diagnosis and treatment of adenomatous polyp can curtail progression to colorectal cancer. F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) reveals the biochemical changes associated with the development of many cancers which precede the appearance of gross anatomical changes that may be visualized during surgical resection or via imaging with MR or CT.
  
  
  METHODS
  We detail the history of a 64 year old female who had a whole-body FDG PET scan as a part of an employee wellness program. A dose of 12.2 mCi of F-18 labeled FDG was administered.
  
  
  RESULTS
  A focal cecal uptake with a standardized uptake value (SUV) of 8.9 was found on the PET scan. Conversely, only normal mucosa was observed during a colonoscopy done 2 months after the PET scan. Motivated by the PET scan finding, the colonoscopist performed a biopsy which revealed a villous adenoma without high grade dysplasia. Pathology from tissue extracted during an exploratory laparatomy completed one month later found the lesion to be a villous adenoma with high grade dysplasia.
  
  
  CONCLUSIONS
  Whole-body FDG PET scan revealed the biochemical metabolic changes in malignancy that preceded the appearance of any gross anatomical abnormality. A positive FDG PET scan indicative of colorectal cancer should be followed up with a colonoscopy and biopsy even in a visibly normal mucosa.
authors: Dept, of Nuclear Medicine/PET, Kettering Medical Center, Southern Blvd, Kettering, OH 45429, USA. bhavya.rehani@kmcnetwork.org.
authors: Bhavya
authors: B
authors: Rehani
authors: Richard M
authors: RM
authors: Chasen
authors: Yvonne
authors: Y
authors: Dowdy
authors: Ankur
authors: A
authors: Bharija
authors: Martin
authors: M
authors: Satter
authors: Pamela
authors: P
authors: Strohmeyer
authors: Joseph
authors: J
authors: Mantil