Rectal lymph node metastasis in recurrent ovarian carcinoma: essential role of 18 F-FDG PET/CT in treatment planning
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Rectal lymph node metastasis in recurrent ovarian carcinoma: essential role of 18F-FDG PET/ CT in treatment planning Koji Kumagai1,7*, Terue Okamura3, Masao Toyoda4, Hideto Senzaki5, Chihiro Watanabe2 and Masahide Ohmichi6
Abstract Although uncommon, ovarian cancer cells may spread to the rectal lymph nodes. However, few reports have described how to detect and treat such metastases. We report a case of a 59-year-old woman with mesorectal and pararectal lymph node metastases in recurrent ovarian carcinoma, detected conclusively using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), and treated by low anterior resection with total mesorectal excision aiming for macroscopic complete resection. The treatment goals for the patient were gradually changed from curative to palliative chemotherapy; she survived for 45 months without rectal obstruction after secondary debulking surgery, and was followed up until autopsy. Thus, 18F-FDG PET/CT may be valuable for detecting rectal lymph node metastasis and can play an essential role in planning treatment for recurrent ovarian carcinoma. Keywords: Recurrent ovarian carcinoma, Mesorectal lymph node, Pararectal lymph node, 18F-FDG PET/CT, Treatment planning
Background Ovarian carcinoma is the most lethal gynecological malignancy, mainly because it extensively metastasizes to various sites through direct invasion, peritoneal dissemination, and lymphatic metastasis [1,2]. Ovarian cancer cells frequently spread to regional lymph nodes such as the iliac and para-aortic nodes [3]. Uncommonly, these cells may also spread to the rectal [4-7], inguinal [8], and intramammary [9] lymph nodes. However, few reports have described how to detect and treat such metastases [10]. Here, we report a case of a 59-year-old woman with mesorectal and pararectal lymph node metastases in recurrent ovarian carcinoma, who survived for 45 months after secondary debulking surgery (SDS) and was followed up until autopsy. We describe the essential role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in treatment planning. * Correspondence: [email protected] 1 Department of Obstetrics and Gynecology, Takatsuki Red Cross Hospital, Takatsuki-city, Osaka 569-1096, Japan 7 Department of Gynecology, Osaka Railway Hospital, 2-22, Matsuzakicho 1chome, Abeno-ku, Osaka-city, Osaka 545-0053, Japan Full list of author information is available at the end of the article
Case presentation A 59-year-old para 2 menopausal woman presented with a 15 cm × 15 cm pelvic tumor. Her mother had a history of breast cancer. The patient’s serum level of cancer antigen 125 (CA125) was elevated to 1,615 U/ml (normal value,
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