Intestinal GIST Mimicking as Adnexal Tumor in FDG-PET/CT Imaging

正子斷層造影下表現形似卵巢腫瘤的小腸胃腸道間質瘤

陳世緯(Shih-Wei Chen) ； 陳遠光(Yen-Kung Chen) ； 楊圳隆(Tsen-Long Yang)

《核子醫學暨分子影像雜誌》 33卷4期 (2020/12) Pp. 254-258

https://doi.org/10.6332/ANMMI.202012_33(4).0004

摘要

A 65-year-old woman received fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the baseline study. One right adnexal tumor with increased FDG uptake was found. Transvaginal ultrasound also revealed a right adnexal mass. The right ovary could not be clearly detected by PET/CT and ultrasound. Her serum CA125 and CA153 levels were within the normal range. Then, she received surgical removal of the tumor. During the operation, a small bowel tumor was observed and was removed with intestinal segmental resection. The final diagnosis was gastrointestinal stromal tumor (GIST). GISTs are the most common mesenchymal tumor in the GI tract, which can arise anywhere along or near the GI tract, and are most common in the stomach and the small intestines. GISTs typically show strong FDG uptake and FDG-PET/CT can be used in primary staging and therapy monitoring. Surgery is the only curative option for resectable tumors. The recurrence rate after the surgery alone is high. Imatinib, sunitinb, and regorafenib have been approved for the treatment of advanced GISTs and the adjuvant therapy after the surgery. Jejunoileal GISTs mimicking gynecologic masses are not uncommon. Gynecologic tumor markers and the use of oral contrast material may aid in the evaluation of pelvic tumors.

關鍵字

adnexal tumor ； gastrointestinal stromal tumor ； fluorine-18 fluorodeoxyglucose ； positron emission tomography/computed tomography

並列摘要

一名65歲婦女接受正子斷層掃描，發現右側卵巢區腫瘤伴隨葡萄糖攝取增加，經陰道超音波亦顯示右側卵巢區腫瘤，腫瘤指數CA125和CA153在正常範圍。於是安排手術切除腫瘤，手術中發現為小腸腫瘤並將其切除，最終診斷為胃腸道間質瘤（gastrointestinal stromal tumor, GIST）。GIST是胃腸道中最常見的間質腫瘤，可能發生於所有胃腸道，最常位於胃和小腸。GIST通常顯示出高度葡萄糖吸收能力，故正子造影可用於其分期和治療效果評估。手術切除是唯一可能治癒的方式，但單純手術切除的復發率並不低。化學治療和放射治療對其效果不佳，但有標靶藥物已證實可用於治療。小腸GIST被誤診為婦科腫瘤的狀況並不少見。婦科腫瘤指數及口服對比劑的使用或許有助於評估骨盆腔腫瘤的位置來源。

並列關鍵字

卵種腫瘤 ； 胃腸道間質瘤 ； 氟-18去氧葡萄糖 ； 正子電腦斷層掃描