A case of pulmonary choriocarcinoma metastasis with unusual FDG-PET and CT findings: correlation with pathology
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CASE REPORT
A case of pulmonary choriocarcinoma metastasis with unusual FDG-PET and CT findings: correlation with pathology Yasuhiro Maruoka • Koichiro Abe • Shingo Baba • Takuro Isoda • Yoshio Matsuo • Yuichiro Kubo • Shinji Ogawa • Tokujiro Yano • Masayuki Sasaki • Hiroshi Honda
Received: 11 June 2012 / Accepted: 23 July 2012 / Published online: 15 August 2012 Ó The Japanese Society of Nuclear Medicine 2012
Abstract A 26-year-old female who had had a hydatidiform mole at 20 years of age showed high levels of serum human chorionic gonadotropin. Because pelvic ultrasound did not show any gestational sac in her uterus, she was suspected to have had an extrauterine pregnancy and a spontaneous abortion. About 6 months later, a pulmonary nodule in the patient’s right upper lung field was found on a routine chest X-ray film. Contrast- enhanced CT scans revealed a solitary lobulated nodule 2.0 9 1.3 9 3.0 cm in diameter in the S2 segment of the right lung. CT suggested a vessel malformation. Positron emission tomography using 2-deoxy2-[18F]fluoro-D-glucose (FDG-PET) was performed and showed weak FDG accumulation (SUVmax = 2.0) in the nodule, which did not positively indicate malignancy.
Y. Maruoka K. Abe (&) S. Baba T. Isoda Y. Matsuo H. Honda Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan e-mail: [email protected] Y. Kubo Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan S. Ogawa Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan T. Yano Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan M. Sasaki Department of Health Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Because a follow-up CT showed a rapid increase in the size of the nodule, partial resection of S2 segment in the right upper lobe was performed. The histopathological diagnosis was a metastasis from choriocarcinoma. The tumor consisted largely of necrosis and hemorrhage, and it was considered to be a major cause of the unusual FDG-PET and CT findings.
Keywords Choriocarcinoma Pulmonary metastasis FDG-PET/CT Weak FDG accumulation
Introduction Choriocarcinoma is the most aggressive tumor of trophoblastic disease, and frequently shows distant hematogenous metastasis to various organs [1]. The most common metastatic sites are the lungs (75 %) and vagina (50 %), but the vulva, kidneys, liver, ovaries, brain, and bowel can also contain metastasis [2]. Although the presence of autonomous secretion of human chorionic gonadotropin (hCG) often helps in the detection of choriocarcinoma lesions, clinical diagnosis of this disease can be complex, as the symptoms vary [1]. Because early diagnosis and sufficient chemotherapy for a choriocarcinoma patient are associated with a good prognosis [3], diagnostic imaging plays an important role in the detection o
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