0:00

Okay, so this was a patient that presented with a right neck mass.

0:06

And when we look at the CT scan,

0:09

what we see are multiple enlarged lymph nodes involving the right

0:14

side of the neck. And one of these is actually cystic here.

0:19

Now at endoscopy there was no evidence of tumor involving

0:24

the visceral space. So there were no tumors in the nasal pharynx.

0:27

There were no tumors in the oral pharynx.

0:29

There were no tumors in the oral cavity, no tumors in the larynx,

0:32

and no tumors in the hypo pharynx.

0:35

So this is an example of a patient that has what we refer to as an unknown

0:40

primary and I believe that you also had a PET CT that was given to you.

0:45

And then when you look at the PET ct,

0:48

what we see is this large, uh, a,

0:52

a lot of uptake involving the right-sided lymph nodes.

0:56

You can see these right-sided lymph nodes and if you have a really sharp eye,

1:01

you can actually see some increased uptake here involving the right tonsil.

1:06

So from a clinical standpoint, this was an unknown primary,

1:10

but on the PET CT we could actually see asymmetrical increase uptake involving

1:15

the right tonsil.

1:16

So this was actually likely due to a early stage right tonsor

1:21

carcinoma that was metastatic to the right-sided lymph nodes.

1:26

And this really is the value add of PET CT for trying to identify,

1:30

to help in identifying the primary site in patients that have a clinical

1:35

unknown primary. So let me stop there and take any questions from you guys.

1:42

Yeah, so

1:43

In us, everyone with the unknown primary will have PET CT scan done.

1:47

Yeah, that's the pretty much standard of care. Right now,

1:51

the detection rate is somewhere between 30 and 50%.

1:54

It depends on the literature and who you read.