INTERESTING IMAGE 18
F-FDG PET/CT and MR Findings of Ovarian Carcinoid Within a Dermoid Cyst
Masahiro Horikawa, MD,* Hiroshi Shinmoto, MD,* Shigeyoshi Soga, MD,* Kosuke Miyai, MD,Þ and Tastumi Kaji, MD* Abstract: Ovarian carcinoid is a rare neoplasm of low-grade malignancy occurring within a dermoid cyst or mucinous tumor, predominantly in perimenopausal women. Reports with radiologic features are scarce. We present a case of a 57-year-old woman with an ovarian carcinoid within a dermoid cyst manifested as a multilocular cystic mass with a solid component showing 18 F-FDG PET uptake (SUVmax = 6.02). Key Words: ovarian carcinoid, dermoid cyst, PET, FDG, MRI (Clin Nucl Med 2014;39: e392Ye394)
Received for publication March 1, 2013; revision accepted August 27, 2013. From the Departments of *Radiology and †Laboratory Medicine, National Defense Medical College, Saitama, Japan. Conflicts of interest and sources of funding: none declared. Reprints: Masahiro Horikawa, MD, Department of Radiology, National Defense Medical College, 3-2Namiki, Tokorozawa, 359-0042 Japan. E-mail: [email protected]. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0363-9762/14/3909Ye392
e392
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REFERENCES 1. Takeuchi M, Matsuzaki K, Uehara H. Primary carcinoid tumor of the ovary: MR imaging characteristics with pathologic correlation. Magn Reson Med Sci. 2011;10:205Y209. 2. Sale E. Ovary: carcinoid, ovary. In: Hricak H, ed. Diagnositic Imaging: Gynecology. 1st ed. Salt Lake City, UT: Amirsys Inc; 2007:134Y137. 3. Takeuchi M, Matsuzaki K, Nishitani H. Diffusion weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr. 2010;34:173Y176. 4. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000;20:1445Y1470. 5. Tavassoli FA, Devilee P. World health organization classification of tumors. In: Tavassoli FA, Devilee P, eds. Pathology and Genetics of Tumors of the Breast and Female Genital Organs. Lyon, France: IARC Press; 2003:172Y173. 6. Davis K, Hartmann L, Kenney G, et al. Primary ovary carcinoid tumors. Gynecol Oncol. 1996;61:259Y265. 7. Gardner GJ, Reidy-Lagunes D, Gehrig PA. Neuroendocrine tumors of the gynecologic tract: a Society of Gynecologic Oncology (SGO) clinical document. Gynecol Oncol. 2011;122:190Y198. 8. Modlin IM, Latich I, Zikusoa M, et al. Gastrointestinal carcinoids: the evolution of diagnostic strategies. J Clin Gastroenterol. 2006;40:572Y582. 9. Belhocine T, Foidart J, Rigo P, et al. Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumors: correlations with the pathological indexes p53 and Ki-67. Nucl Med Commun. 2002;23:727Y734. 10. Marom EM, Sarvis S, Herndon JE 2nd, et al. T1 lung cancers: sensitivity of diagnosis with fluorodeoxyglucose PET. Radiology. 2002;223:453Y459.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
18
F-FDG PET/CT & MR Findings of Ovarian Carcinoid
FIGURE 1. A 57-year-old asymptomatic postmenopausal woman was admitted to evaluate a 13-cm right ovarian cystic mass initially detected by screening transabdominal ultrasonography 15 months previously as a 10-cm mass. Physical examination was unremarkable; there was no relevant family history or medical history, serum CA-19-9 elevated at 114 U/mL (reference, G37U/mL). Noncontrast (A) and contrast-enhanced CT (B) showed a well-defined predominantly fatty multilocular cystic mass with mildly enhancing solid component.
FIGURE 2. Axial T1-weighted (A), T2-weighted (B), and diffusion-weighted MR images with black and white reversal (b = 1000 s/mm2) (C), axial (D), and coronal (E) images of 18F-FDG PET/CT. The solid compartment showed markedly low signal intensity on T2-weighted image and restricted diffusion (ADC value = 0.58 10j3 mm2/s), and marked 18F-FDG PET uptake (SUVmax = 6.02). The characteristic fat-containing CT and MR findings of the cystic lesion are characteristic for a dermoid cyst, whereas the solid component is suggestive of a carcinoid, with low signal intensity on T2-weighted MR imaging, restricted diffusion, and increased 18F-FDG PET uptake.1Y4 A total hysterectomy and bilateral salpingo-oophorectomy were performed. * 2013 Lippincott Williams & Wilkins
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Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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Clinical Nuclear Medicine
Horikawa et al
& Volume 39, Number 9, September 2014
FIGURE 3. Gross specimen (A), low-power (B) (hematoxylin-eosin stain, original magnification 40), and high-power (C) (hematoxylin-eosin stain, original magnification 200) photomicrographs of the solid compartment. High-power photomicrographs with chromogranin A stain (D) and synaptophysin stain (E). Tumor cells are arranged in characteristic trabecular pattern. Immunohistochemical staining demonstrates that the tumor cells are positive for chromogranin A and synaptophysin. On the basis of the morphologic and immunohistochemical findings, giving a pathologic diagnosis of ovarian trabecular carcinoid.5Y7 The pathologic features of cystic lesion were characteristic for a dermoid cyst. Solid benign fibrous tumors, such as fibromas, thecomas, cystadenofibromas, and Brenner tumors, are often associated with low signal intensity on T2-weighted MR images1Y4; however, uncommon low-grade-malignant carcinoid tumors are also known to be demonstrated similarly and difficult to differentiate from the benign fibrous tumors preoperatively.1 Sensitivity of 18F-FDG PET has been reported to be 25% to 73% in gastrointestinal carcinoid tumors8,9 and carcinoids in other part of the body,10 whereas there is no single report of 18 F-FDG PET for ovarian carcinoid. 18F-FDG PET may play an important role for preoperative diagnosis of ovarian carcinoids, especially in case of a solid mass demonstrating low signal intensity on T2-weighted MR image accompanied with a dermoid cyst.
e394
www.nuclearmed.com
* 2013 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
F-FDG PET/CT and MR Findings of Ovarian Carcinoid Within a Dermoid Cyst
Masahiro Horikawa, MD,* Hiroshi Shinmoto, MD,* Shigeyoshi Soga, MD,* Kosuke Miyai, MD,Þ and Tastumi Kaji, MD* Abstract: Ovarian carcinoid is a rare neoplasm of low-grade malignancy occurring within a dermoid cyst or mucinous tumor, predominantly in perimenopausal women. Reports with radiologic features are scarce. We present a case of a 57-year-old woman with an ovarian carcinoid within a dermoid cyst manifested as a multilocular cystic mass with a solid component showing 18 F-FDG PET uptake (SUVmax = 6.02). Key Words: ovarian carcinoid, dermoid cyst, PET, FDG, MRI (Clin Nucl Med 2014;39: e392Ye394)
Received for publication March 1, 2013; revision accepted August 27, 2013. From the Departments of *Radiology and †Laboratory Medicine, National Defense Medical College, Saitama, Japan. Conflicts of interest and sources of funding: none declared. Reprints: Masahiro Horikawa, MD, Department of Radiology, National Defense Medical College, 3-2Namiki, Tokorozawa, 359-0042 Japan. E-mail: [email protected]. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0363-9762/14/3909Ye392
e392
www.nuclearmed.com
REFERENCES 1. Takeuchi M, Matsuzaki K, Uehara H. Primary carcinoid tumor of the ovary: MR imaging characteristics with pathologic correlation. Magn Reson Med Sci. 2011;10:205Y209. 2. Sale E. Ovary: carcinoid, ovary. In: Hricak H, ed. Diagnositic Imaging: Gynecology. 1st ed. Salt Lake City, UT: Amirsys Inc; 2007:134Y137. 3. Takeuchi M, Matsuzaki K, Nishitani H. Diffusion weighted magnetic resonance imaging of ovarian tumors: differentiation of benign and malignant solid components of ovarian masses. J Comput Assist Tomogr. 2010;34:173Y176. 4. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000;20:1445Y1470. 5. Tavassoli FA, Devilee P. World health organization classification of tumors. In: Tavassoli FA, Devilee P, eds. Pathology and Genetics of Tumors of the Breast and Female Genital Organs. Lyon, France: IARC Press; 2003:172Y173. 6. Davis K, Hartmann L, Kenney G, et al. Primary ovary carcinoid tumors. Gynecol Oncol. 1996;61:259Y265. 7. Gardner GJ, Reidy-Lagunes D, Gehrig PA. Neuroendocrine tumors of the gynecologic tract: a Society of Gynecologic Oncology (SGO) clinical document. Gynecol Oncol. 2011;122:190Y198. 8. Modlin IM, Latich I, Zikusoa M, et al. Gastrointestinal carcinoids: the evolution of diagnostic strategies. J Clin Gastroenterol. 2006;40:572Y582. 9. Belhocine T, Foidart J, Rigo P, et al. Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumors: correlations with the pathological indexes p53 and Ki-67. Nucl Med Commun. 2002;23:727Y734. 10. Marom EM, Sarvis S, Herndon JE 2nd, et al. T1 lung cancers: sensitivity of diagnosis with fluorodeoxyglucose PET. Radiology. 2002;223:453Y459.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Clinical Nuclear Medicine
& Volume 39, Number 9, September 2014
18
F-FDG PET/CT & MR Findings of Ovarian Carcinoid
FIGURE 1. A 57-year-old asymptomatic postmenopausal woman was admitted to evaluate a 13-cm right ovarian cystic mass initially detected by screening transabdominal ultrasonography 15 months previously as a 10-cm mass. Physical examination was unremarkable; there was no relevant family history or medical history, serum CA-19-9 elevated at 114 U/mL (reference, G37U/mL). Noncontrast (A) and contrast-enhanced CT (B) showed a well-defined predominantly fatty multilocular cystic mass with mildly enhancing solid component.
FIGURE 2. Axial T1-weighted (A), T2-weighted (B), and diffusion-weighted MR images with black and white reversal (b = 1000 s/mm2) (C), axial (D), and coronal (E) images of 18F-FDG PET/CT. The solid compartment showed markedly low signal intensity on T2-weighted image and restricted diffusion (ADC value = 0.58 10j3 mm2/s), and marked 18F-FDG PET uptake (SUVmax = 6.02). The characteristic fat-containing CT and MR findings of the cystic lesion are characteristic for a dermoid cyst, whereas the solid component is suggestive of a carcinoid, with low signal intensity on T2-weighted MR imaging, restricted diffusion, and increased 18F-FDG PET uptake.1Y4 A total hysterectomy and bilateral salpingo-oophorectomy were performed. * 2013 Lippincott Williams & Wilkins
www.nuclearmed.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
e393
Clinical Nuclear Medicine
Horikawa et al
& Volume 39, Number 9, September 2014
FIGURE 3. Gross specimen (A), low-power (B) (hematoxylin-eosin stain, original magnification 40), and high-power (C) (hematoxylin-eosin stain, original magnification 200) photomicrographs of the solid compartment. High-power photomicrographs with chromogranin A stain (D) and synaptophysin stain (E). Tumor cells are arranged in characteristic trabecular pattern. Immunohistochemical staining demonstrates that the tumor cells are positive for chromogranin A and synaptophysin. On the basis of the morphologic and immunohistochemical findings, giving a pathologic diagnosis of ovarian trabecular carcinoid.5Y7 The pathologic features of cystic lesion were characteristic for a dermoid cyst. Solid benign fibrous tumors, such as fibromas, thecomas, cystadenofibromas, and Brenner tumors, are often associated with low signal intensity on T2-weighted MR images1Y4; however, uncommon low-grade-malignant carcinoid tumors are also known to be demonstrated similarly and difficult to differentiate from the benign fibrous tumors preoperatively.1 Sensitivity of 18F-FDG PET has been reported to be 25% to 73% in gastrointestinal carcinoid tumors8,9 and carcinoids in other part of the body,10 whereas there is no single report of 18 F-FDG PET for ovarian carcinoid. 18F-FDG PET may play an important role for preoperative diagnosis of ovarian carcinoids, especially in case of a solid mass demonstrating low signal intensity on T2-weighted MR image accompanied with a dermoid cyst.
e394
www.nuclearmed.com
* 2013 Lippincott Williams & Wilkins
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
![[Struma carcinoid tumor within a dermoid cyst as an incidental finding in cesarean section].](/assets/img/hold.png)
