Leydig cell tumor incidentally detected by fused FDG-PET/MRI
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ENDOCRINE IMAGING
Leydig cell tumor incidentally detected by fused FDG-PET/MRI Giorgio Treglia • Vittoria Espeli • Luca Giovanella
Received: 21 December 2014 / Accepted: 16 January 2015 Ó Springer Science+Business Media New York 2015
A 67-year-old female patient with history of a colonic adenocarcinoma surgically removed 3 years before (stage pT2N0M0) underwent fused fluorine-18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (FDG-PET/MRI) for restaging due to increased serum carcinoembryonic antigen levels with negative ultrasonography (US) and computed tomography (CT) of abdomen and pelvis. FDG-PET/MRI demonstrated an area of increased tracer uptake corresponding to a 1.5-cm nodule located in the left ovary (Fig. 1). No other lesions were detected in the rest of the body. According to the FDG-PET/MRI findings, increased serum androgen levels (testosterone was 18 nmol/L) and polycythemia raised the suspicion of a hyperfunctioning ovarian tumor. Therefore the patient underwent left salpingo-oophorectomy and histology demonstrated the presence of a well-differentiated Leydig cell tumor (LCT). At follow-up, a significant decrease of serum androgens levels compared to the baseline was observed (testosterone decreased to 3 nmol/L).
LCT is a rare hyperfunctioning tumor of the ovary accounting for less than 0.2 % of all ovarian neoplasms. It occurs most frequently in the second and third decades, with a good long-term prognosis which is usually related to stage and histologic differentiation. LCT is unilateral in most of the patients and it is usually associated with hyperandrogenic symptoms, but it may be asymptomatic in some cases. Surgery is the mainstay of treatment [1]. Some cases in the literature described the usefulness of FDG-PET/CT in evaluating LCTs [2, 3]. The combination of functional (by FDG-PET) and morphological data (by MRI or CT) may increase the accuracy in detecting these generally slow-growing tumors compared to these imaging methods alone. However, a less-invasive and less-expensive approach, such as ovarian contrast-enhanced US, could be indicated in this setting. In our case, fused FDG-PET/MRI has been useful in incidentally detecting this rare hyperfunctioning ovarian tumor in a patient with hyperandrogenism and previous cancer history.
G. Treglia (&) L. Giovanella Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Via Ospedale, 12, 6500 Bellinzona, Switzerland e-mail: [email protected] V. Espeli Division of Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Endocrine Fig. 1 Maximum intensity projection (a) and axial F-18FDG-PET (b), MRI (c) and fused PET/MRI images (d) showing an area of increased radiopharmaceutical uptake (maximal standardized uptake value 5.5) corresponding to a 1.5-cm lesion of the left ovary (yellow arrows). Histology demonstrated the presence of a well-differentiated Leydig cell tumor
Conflict of interest The authors declare that they have no conflicts of i
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