18 F-FDG PET/CT Imaging of Peritoneal Fibrosis Mimicking Persistent Metastatic Ovarian Carcinoma
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CASE REPORT
18
F-FDG PET/CT Imaging of Peritoneal Fibrosis Mimicking Persistent Metastatic Ovarian Carcinoma Benjamin Leroy-Freschini 1
&
Véronique Lindner 2 & Thomas Boisramé 3 & Martin Demarchi 4
Received: 9 June 2020 / Revised: 9 July 2020 / Accepted: 16 July 2020 # Korean Society of Nuclear Medicine 2020
Abstract A 65-year-old woman was addressed for clinical and biological suspicion of ovarian cancer relapse. 18F-FDG PET/CT revealed massive peritoneal carcinomatosis. Post-chemotherapy PET/CT showed complete metabolic response in initial localizations albeit three new 18F-FDG uptakes appeared in the mesentery and in the retro-hepatic space. Close follow-up (including PET/ CT scan) and surgical examination of the abdominal cavity confirmed the absence of malignancy and the benign nature of these lesions, which appeared to be peritoneal fibrosis mimicking persistent carcinomatosis. Keywords 18F-FDG PET . Peritoneal carcinomatosis . Peritoneal fibrosis . Metastatic ovarian cancer
Introduction
Case Report
Due to its non-specific uptake in peritoneal lesions, 18F-FDG can mimic peritoneal carcinomatosis. Differential diagnosis is challenging in gynecological malignancies and surgical confirmation is warranted.
A 65-year-old woman previously treated for FIGO IIIB ovarian papillary serous carcinoma (surgery and chemotherapy) was referred to our institution for evaluation of abdominal pain and tumor markers increase (CA-125, 74 U/ml; reference, < 35), suggesting ovarian cancer relapse. In addition to oncological laparotomy, the patient has been through abdominal surgeries for eventration and hernia repair. 18F-FDG PET/CT demonstrated massive hypermetabolic peritoneal carcinomatosis (Fig. 1c; SUVmax 17.5). Chemotherapy was initiated (carboplatin and doxorubicin): 6 months later and after 6 cycles, markers dropped (CA-125, 11 U/ml) and 18F-FDG PET/ CT showed complete metabolic response in all initial localizations. However, two isodense ill-defined and hypermetabolic tissue infiltrations appeared in the mesentery (Fig. 2a–c, red arrows; SUVmax 9.4). Another peritoneal 18F-FDG uptake without radiological substratum was identified on the posterior side of the liver (Fig. 2c, black arrow; SUVmax 5.2). In order to explore these new lesions, surgical examination of the abdominal cavity was decided rather than initiating maintenance treatment with PARP inhibitor. Laparoscopic exploration found calcified fibrotic lesions in the peritoneum, and lavage cytology found no neoplastic lesion. Histopathological examination of biopsies of the peritoneal cavity disclosed a background of fibrosis with mononucleated foamy macrophagic infiltrate (Fig. 3a), multinucleated giant cells incorporating some birefringent foreign bodies (Fig. 3b, arrow), and fibrosis containing some calcifications and psammoma bodies (Fig. 3c,
* Benjamin Leroy-Freschini [email protected] Véronique Lindner [email protected] Thomas Boisramé [email protected] Martin Demarchi [email protected] 1
Department of N
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