Vol 72, No 2 (2022)
Pictures in Oncology
Published online: 2022-02-14

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Synchronous cervical and ovarian cancer detected with 18F-FDG PET/CT examination

Kamila Kaźmierczak1, Witold Cholewiński2, Anna Filipczuk2, Błażej Nowakowski1
Nowotwory. Journal of Oncology 2022;72(2):129.

Abstract

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NOWOTWORY Journal of Oncology

2022, volume 72, number 2, 129

DOI: 10.5603/NJO.a2022.0014

© Polskie Towarzystwo Onkologiczne

ISSN 0029–540X, e-ISSN: 2300-2115

www.nowotwory.edu.pl

Synchronous cervical and ovarian cancer detected with 18F-FDG PET/CT examination

Pictures in oncology

Kamila Kaźmierczak1Witold Cholewiński2Anna Filipczuk2Błażej Nowakowski1
1Surgical, Oncological and Endoscopic Gynaecology Department, Greater Poland Cancer Centre, Poznan, Poland
2Nuclear Medicine Unit, Greater Poland Cancer Centre, Poznan, Poland

How to cite:

Kaźmierczak K, Cholewiński W, Filipczuk A, Nowakowski B. Synchronous cervical and ovarian cancer detected with 18F-FDG PET/CT examination. NOWOTWORY J Oncol 2022; 72: 129.

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 68-year-old patient was referred to the Gynecologic Oncology Outpatient Clinic with a diagnosis of bilateral ovarian tumors. The medical interview revealed that the patient had not had a gynecological examination in a long time. The ovarian tumors were evaluated with the risk of malignancy index (RMI) based on the serum CA-125 level, menopausal status, and ultrasound features. The high RMI score of 240 suggested malignant hyperplasia. Next, positron emission tomography/computed tomography with 18F-fluorodeoxyglucose as a radiopharmaceutical (18F-FDG PET/CT) was performed; the scan revealed a primary malignant lesion in the left ovarian tumor and cervix (fig. 1–2). Subsequent cervical diagnostics and a histopathological examination confirmed the coexistence of cervical cancer. The patient was qualified for surgery using a total hysterectomy with bilateral salpingoophorectomy and surgical staging. The evaluation of resected material confirmed left ovarian cancer (FIGO 2014 stage IA G3) and cervical cancer (FIGO 2018 stage IB1 G2). Radiotherapy was used as adjuvant treatment. Currently, the patient is under observation. The PET/CT examination is useful in assessing ovarian cancer and has shown efficacy in the diagnosis of lymph node lesions (96% accuracy) and distant metastases [1]. In the case of cervical cancer, a PET/CT scan can aid in diagnosing lesions as small as 7 mm [2].

Figure 1. A litho-cystic tumor (78 x 76 x 75 mm) in the left pelvis. The upper solid part of the tumor (44 x 34 x 3 mm) shows a high accumulation of FDG with a maximum standardized uptake value (SUVmax) of 11.0 and the features of an aggressive proliferative process
Figure 2. A hypodense area (19 mm in diameter) in the cervix with a slightly increased accumulation of FDG (SUVmax up to 2.9) and metabolic features suggesting a primary malignant lesion (transverse projection)

References

  1. Fularz M, Adamiak P, Czepczyński R, et al. Positron emission tomography (PET) in malignant ovarian tumors. Ginekol Pol. 2013; 84(8): 720–725, doi: 10.17772/gp/1630, indexed in Pubmed: 24191507.
  2. Mirpour S, Mhlanga JC, Logeswaran P, et al. The role of PET/CT in the management of cervical cancer. AJR Am J Roentgenol. 2013; 201(2): W192–W205, doi: 10.2214/AJR.12.9830, indexed in Pubmed: 23883234.



Nowotwory. Journal of Oncology