Applying F-18 Fluorodeoxyglucose-PET/CT to Identify Ovarian Cancer in a Patient with Peritoneal Carcinomatosis from Unknown Primary Site

於原發部位不明之腹膜多發性癌病變者運用氟-18去氧葡萄糖－正子斷層造影（PET／CT）發現卵巢癌

林秘生(Mi-sheng Lin) ； 石志安(Chih-An Shih) ； 彭南靖(Nan-Jing Peng) ； 許秉毅(Ping-I Hsu)

《核子醫學暨分子影像雜誌》 26卷4期 (2013/12) Pp. 154-157+IV

https://doi.org/10.3966/222696812013122604006

摘要

Searching for the primitive tumor of a peritoneal carcinomatosis is sometimes a difficult task even with modem diagnostic modalities. However, it is of paramount importance to identify primary tumors in patients with peritoneal carcinomatosis, which are responsive to systemic chemotherapy and/or locoregional treatment. We presented a 74-years old female patient with massive malignant ascites. Abdominal computed tomography (CT) and Gallium scan failed to detect primary origin of peritoneal carcinomatosis. F-18 fluorodeoxyglucose (FDG) PET/CT showed a FDG-avid lesion in right ovary with multiple FDG-avid nodules over mesentery and retroperitoneum. Under the impression of right ovarian cancer with peritoneal seeding, she underwent cytoreductive surgery with total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node, para-aortic lymph node dissection and partial omentectomy. Chemotherapy with avstin, taxol and carboplatin was administered following operation. The patient remained well after 4-month of follow-up. Her CA-125 and CA-199 went down and ascites resolved completely. Our data strongly suggest the combined F-18 FDG PET/CT is helpful in identifying primary tumor origin in some patients with peritoneal carcinomatosis, whose primary cancer cannot be detected by conventional diagnostic modalities.

關鍵字

computed tomography (CT) ； peritoneal carcinomatosis ； positron Emission Tomography (PET)

並列摘要

即使是目前的診斷設備，找尋腹膜轉移腫瘤（peritoneal carcinomatosis）的原發病灶仍是困難的任務。然而，確定原發病灶是非常重要的，因為可能對我們所提供的化學治療和局部放射治療有良好反應。我們探討一位74歲的表現出大量腹水的女性病人。腹部電腦斷層掃描（CT）和全身鎵-67掃描（Galium scan）未能檢測到腹膜轉移癌的原發病灶。氟1-8去氧葡萄糖正子斷層造影（PET／CT）表現FDG熱點（FDG-avid）的多重右側卵巢結節和後腹膜結節。鑒於右側卵巢腫瘤合併腹膜轉移的診斷，她接受全子宮切除術、雙側輸卵管及卵巢切除、雙側骨盆淋巴結廓清術、腹主動脈旁淋巴結廓清術。病理報告顯示右側卵巢漿液性腫瘤，侵犯右側輸卵管、左側卵巢、左側輸卵管、子宮以及腹膜轉移。經過良好的術後照護以及化學治療，在四個月的追蹤時間後，她的CA-125和CA-199回到正常範圍內，並且腹水完全消退。我們的資料顯示：對於傳統的影像檢查則無法偵測原發病灶之腹膜轉移腫瘤，氯-18去氧葡萄糖正子斷層造影有助於發現原發部位。

並列關鍵字

電腦斷層 ； 卵巢癌 ； 腹膜轉移 ； 正子斷層造影