INTERESTING IMAGE
Increased 18F-FDG Uptake of Widespread Endometriosis Mimicking Ovarian Malignancy Jingjie Ge, BD,* Chuantao Zuo, MD,* Yihui Guan, MD,* and Xuyin Zhang, MD,† Abstract: Endometriosis is a benign disease characterized by the implantation of functional endometrial tissue in ectopic locations. We present a case of a 42-yearold woman with widespread endometriosis that mimicked ovarian malignancy on FDG PET/CT. Increased FDG uptake was observed not only in the right ovary, but also in the liver capsule, perihepatic nodules, greater omentum, and the mesentery. This case indicates that widespread endometriosis may be a cause of multiple FDG uptakes in women of reproductive age and should always be kept in mind in the differential diagnoses of suspicious malignancy. Key Words: endometriosis, FDG, PET/CT (Clin Nucl Med 2015;40: 186–188)
Received for publication June 23, 2014; revision accepted October 27, 2014. From the *PET Center, Huashan Hospital, and †Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China. Conflicts of interest and sources of funding: Supported by grants from the China-US Biomedical Collaborative Research Program (No. 81361120393) and the National Foundation of Natural Science of China (No. 81171189). Reprints: Xuyin Zhang, MD, Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Rd, Shanghai 200090, People's Republic of China. E-mail: [email protected]. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4002–0186
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REFERENCES 1. Zhu Z, Li F, Zhuang H. Gastric distension by ingesting food is useful in the evaluation of primary gastric cancer by FDG PET. Clin Nucl Med. 2007;32: 106–109. 2. Kamimura K, Nagamachi S, Wakamatsu H, et al. Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on 18F-fluoro-2-deoxy-D-glucose PET. Nucl Med Commun. 2009;30:431–439. 3. Hansen KA. What is new in endometriosis? Best articles from the past year. Obstet Gynecol. 2013;121:1104–1106. 4. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364:1789–1799. 5. Bulun SE. Endometriosis. N Engl J Med. 2009;360:268–279. 6. Prabhu R, Krishna S, Shenoy R, et al. Endometriosis of extra-pelvic round ligament, a diagnostic dilemma for physicians. BMJ Case Rep. 2013;2013:1–3. 7. Brawn J, Morotti M, Zondervan KT, et al. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014;20:737–747. 8. Schindler AE. Pathophysiology, diagnosis and treatment of endometriosis. Minerva Ginecol. 2004;56:419–435. 9. Augoulea A, Lambrinoudaki I, Christodoulakos G. Thoracic endometriosis syndrome. Respiration. 2008;75:113–119. 10. Huang H, Li C, Zarogoulidis P, et al. Endometriosis of the lung: report of a case and literature review. Eur J Med Res. 2013;18:13.
Clinical Nuclear Medicine • Volume 40, Number 2, February 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 2, February 2015
Widespread Endometriosis Mimicking Malignancy
FIGURE 1. A 42-year-old woman was referred to the hospital because of acute abdominal pain for 7 hours. The physical examination was unremarkable, but laboratory test results showed elevated levels of serum CA125 (1088 U/mL; reference range,
Increased 18F-FDG Uptake of Widespread Endometriosis Mimicking Ovarian Malignancy Jingjie Ge, BD,* Chuantao Zuo, MD,* Yihui Guan, MD,* and Xuyin Zhang, MD,† Abstract: Endometriosis is a benign disease characterized by the implantation of functional endometrial tissue in ectopic locations. We present a case of a 42-yearold woman with widespread endometriosis that mimicked ovarian malignancy on FDG PET/CT. Increased FDG uptake was observed not only in the right ovary, but also in the liver capsule, perihepatic nodules, greater omentum, and the mesentery. This case indicates that widespread endometriosis may be a cause of multiple FDG uptakes in women of reproductive age and should always be kept in mind in the differential diagnoses of suspicious malignancy. Key Words: endometriosis, FDG, PET/CT (Clin Nucl Med 2015;40: 186–188)
Received for publication June 23, 2014; revision accepted October 27, 2014. From the *PET Center, Huashan Hospital, and †Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China. Conflicts of interest and sources of funding: Supported by grants from the China-US Biomedical Collaborative Research Program (No. 81361120393) and the National Foundation of Natural Science of China (No. 81171189). Reprints: Xuyin Zhang, MD, Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Rd, Shanghai 200090, People's Republic of China. E-mail: [email protected]. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4002–0186
186
www.nuclearmed.com
REFERENCES 1. Zhu Z, Li F, Zhuang H. Gastric distension by ingesting food is useful in the evaluation of primary gastric cancer by FDG PET. Clin Nucl Med. 2007;32: 106–109. 2. Kamimura K, Nagamachi S, Wakamatsu H, et al. Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on 18F-fluoro-2-deoxy-D-glucose PET. Nucl Med Commun. 2009;30:431–439. 3. Hansen KA. What is new in endometriosis? Best articles from the past year. Obstet Gynecol. 2013;121:1104–1106. 4. Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364:1789–1799. 5. Bulun SE. Endometriosis. N Engl J Med. 2009;360:268–279. 6. Prabhu R, Krishna S, Shenoy R, et al. Endometriosis of extra-pelvic round ligament, a diagnostic dilemma for physicians. BMJ Case Rep. 2013;2013:1–3. 7. Brawn J, Morotti M, Zondervan KT, et al. Central changes associated with chronic pelvic pain and endometriosis. Hum Reprod Update. 2014;20:737–747. 8. Schindler AE. Pathophysiology, diagnosis and treatment of endometriosis. Minerva Ginecol. 2004;56:419–435. 9. Augoulea A, Lambrinoudaki I, Christodoulakos G. Thoracic endometriosis syndrome. Respiration. 2008;75:113–119. 10. Huang H, Li C, Zarogoulidis P, et al. Endometriosis of the lung: report of a case and literature review. Eur J Med Res. 2013;18:13.
Clinical Nuclear Medicine • Volume 40, Number 2, February 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 2, February 2015
Widespread Endometriosis Mimicking Malignancy
FIGURE 1. A 42-year-old woman was referred to the hospital because of acute abdominal pain for 7 hours. The physical examination was unremarkable, but laboratory test results showed elevated levels of serum CA125 (1088 U/mL; reference range,
