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Drolia B, Gupta N, Verma R, Belho ES, Dhawan S. Follow-up 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Evaluation of a Torsion of Uterine Fibroid in an Elderly Female. Indian J Nucl Med 2020; 35:330-332. [PMID: 33642759 PMCID: PMC7905289 DOI: 10.4103/ijnm.ijnm_104_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/04/2022] Open
Abstract
Fibroids are rare in postmenopausal females. Torsion of pedunculated uterine fibroid is also a very rare occurrence in elderly females. We report a rare case of an 84-year-old multiparous, postmenopausal female, a treated case of non-Hodgkin's lymphoma, presenting with a large abdominal mass. The comparative positron emission tomography/computed tomography scan study of the patient revealed that a new mass in the abdomen and pelvis connected with the left adnexa with a pedicle and previously seen fibroid was not visualized on the present scan, thus raising suspicion of torsion of subserosal fibroid. Histopathology confirmed the diagnosis of fibroid.
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Affiliation(s)
- Babita Drolia
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Gupta
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ritu Verma
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Ethel Shangne Belho
- Department of Nuclear Medicine, Mahajan Imaging Centre, Sir Ganga Ram Hospital, New Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
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Abstract
RATIONALE Uterine fibroids are the most common pelvic solid tumors and common to 25% of women. F-fluorodexyglucose (F-FDG) is an energy metabolism tracer. Although FDG is generally concentrated in malignant lesions with high glucose metabolism, it can also accumulate in normal tissues, benign lesions, and inflammatory sites. The exact mechanism of FDG uptake by uterine fibroids is not clear. Here, we report a case of uterine fibroids with positive F-FDG positron emission tomography/computed tomography (PET/CT) imaging and significantly increased CA19-9. PATIENTS CONCERNS The patient was a 43-year-old woman and admitted to our hospital because of "1-year-extended menstrual periods." At admission, she had normal CA125, AFP, and CEA level and CA19-9>1000.00 U/mL. Gynecological transvaginal ultrasound found enlarged uterus with an anterior hypoechoic area of 3.9 × 4.2 cm. CT and contrast-enhanced CT showed significantly enhanced mass shadow on the left anterior wall of uterus. F-FDG PET/CT showed increased FDG metabolism of tumor in the anterior wall of the uterus. INTERVENTIONS Laparoscopic hysterectomy was performed. DIAGNOSIS Pathological examination demonstrated subserosal leiomyoma. OUTCOMES Her CA19-9 level dropped to 91.50 U/mL 1 day after surgery. LESSONS Significantly elevated CA19-9 was positioned in the uterus by PET/CT imaging, which not only avoided unnecessary gastrointestinal endoscopy and reduced the suffering of patients, but also strengthened the operation confidence in gynecologists.
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Affiliation(s)
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Ma Y, Shao X, Shao X, Wang X, Wang Y. High metabolic characteristics of uterine fibroids in 18F-FDG PET/CT imaging and the underlying mechanisms. Nucl Med Commun 2016; 37:1206-11. [DOI: 10.1097/mnm.0000000000000558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wen K, Horng H, Wang P, Chen Y, Yen M, Ng H, Chang Y, Chang Y, Chao H, Chao K, Chuang C, Ho C, Huang C, Hung Z, Jiang L, Lau H, Li H, Lin C, Liu C, Sun P, Twu N, Wu H, Yu H, Ju F, Tsai C, Chang W, Hsu Y, Lee N, Chen C, Chang T, Chang W, Chen C, Chen R, Chow S, Lien Y, Sheu B, Torng P, Yen M, Lee W, Wang K, Chang C, Chen C, Chen J, Chen T, Huang J, Huang M, Wang Y, Chang C, Liu J, Su H, Wang Y, Yu M, Huang L, Seow K, Lai T, Lee F, Chen C, Huang B, Hsiao S, Sun H, Wu W, Teng S, Chen K, Hung J, Lai H, Yuan C, Hsieh C, Wang C, Chang S, Hung M, Hsu S, Ke Y, Lu C, Sun L, Chang W, Hung Y, Lin W, Wang P, Chen T, Li Y, Wu M, Huang K, Fu H, Chen S, Chiang A, Li J, Lin L, Tsai H, Tsui K. Uterine sarcoma Part I—Uterine leiomyosarcoma: The Topic Advisory Group systematic review. Taiwan J Obstet Gynecol 2016; 55:463-71. [DOI: 10.1016/j.tjog.2016.04.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/21/2022] Open
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Peng K, Jiang LY, Teng SW, Wang PH. Degenerative leiomyoma of the cervix: Atypical clinical presentation and an unusual finding. Taiwan J Obstet Gynecol 2016; 55:293-5. [DOI: 10.1016/j.tjog.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 10/21/2022] Open
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Zhang R, Tian X, Qin L, Lu D, Shen J. High 18F-FDG Uptake For Uterine Smooth Muscle Tumor of Uncertain Malignant Potential. Clin Nucl Med 2015; 40:349-51. [DOI: 10.1097/rlu.0000000000000727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Horng H, Chen C, Chen C, Tsui K, Liu W, Wang P, Chang W, Huang B, Sun H, Chang T, Chang W, Yen M. Uterine-sparing surgery for adenomyosis and/or adenomyoma. Taiwan J Obstet Gynecol 2014; 53:3-7. [DOI: 10.1016/j.tjog.2014.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/18/2022] Open
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Park JH, Han JY, Hyun IY, Lee BI, Moon YS. Case of uterine leiomyoma showing fludeoxyglucose uptake on F-18 fludeoxyglucose positron emission tomography/computed tomography. J Obstet Gynaecol Res 2010; 36:1261-4. [PMID: 21083837 DOI: 10.1111/j.1447-0756.2010.01307.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In order not to over treat uterine leiomyoma and to avoid overlooking uterine leiomyosarcoma, a highly reliable diagnostic method has been thought. Occasionally, it is difficult to discriminate uterine leiomyoma from uterine leiomyosarcoma. Recently positron emission tomography/computed tomography (PET/CT) has been proved useful in assessing pelvic malignancies. We experienced a case of uterine leiomyoma showing increased F-18 fludeoxyglucose uptake on PET/CT in a postmenopausal woman. However, histological analysis demonstrated benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed negative in leiomyoma. Our case indicates that uterine leiomyoma in a postmenopausal woman may show false positive result of PET/CT.
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Affiliation(s)
- Jee Hyun Park
- Department of Obstetrics and Gynecology, Laboratory Medicine, College of Medicine, Inha University, Incheon, Korea
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Tsukada H, Murakami M, Shida M, Kikuchi K, Watanabe M, Yasuda S, Suzuki Y. 18F-Fluorodeoxyglucose uptake in uterine leiomyomas in healthy women. Clin Imaging 2009; 33:462-7. [DOI: 10.1016/j.clinimag.2009.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 02/10/2009] [Indexed: 11/18/2022]
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Wang PH, Lee WL, Cheng MH, Yen MS, Chao KC, Chao HT. Use of a Gonadotropin-Releasing Hormone Agonist to Manage Perimenopausal Women With Symptomatic Uterine Myomas. Taiwan J Obstet Gynecol 2009; 48:133-7. [DOI: 10.1016/s1028-4559(09)60273-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC. Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res 2009; 35:495-502. [DOI: 10.1111/j.1447-0756.2008.00951.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lee WL, Yuan CC, Wang PH. Positron emission tomography and uterine leiomyomas. Gynecol Oncol 2007; 107:593-4; author reply 594-5. [PMID: 17826823 DOI: 10.1016/j.ygyno.2007.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 08/06/2007] [Indexed: 11/22/2022]
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Shida M, Murakami M, Tsukada H, Ishiguro Y, Kikuchi K, Yamashita E, Kajiwara H, Yasuda M, Ide M. F-18 fluorodeoxyglucose uptake in leiomyomatous uterus. Int J Gynecol Cancer 2007; 17:285-90. [PMID: 17291269 DOI: 10.1111/j.1525-1438.2006.00778.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Leiomyomas of uterus are common disease in gynecology. It is important to differentiate leiomyoma from leiomyosarcoma at the decision of treatment methods, especially in the case of the conservative treatment for uterine leiomyoma. But the exact diagnosis of benign leiomyoma is often difficult due to the degeneration of myoma by imaging modalities including magnetic resonance imaging. Recently, whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) has been used for a diagnosis of malignant tumors. There is a growing body of evidence for the use of FDG in differentiating malignant from benign disease. But optimal utilization in gynecology remains unclear. Our case represents increased uptake of FDG in myomatous uterus, which is pathologically confirmed benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed positive in endometrial tissue and negative in leiomyoma. Our case indicates that myomatous uterus in premenopausal women shows the potential pitfall of a positive result of FDG-PET.
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Affiliation(s)
- M Shida
- Department of Obstetrics & Gynecology, Tokai University School of Medicine, Kanagawa 159-0198, Japan
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Liu WM, Wang PH, Tang WL, Wang IT, Tzeng CR. Uterine artery ligation for treatment of pregnant women with uterine leiomyomas who are undergoing cesarean section. Fertil Steril 2006; 86:423-8. [PMID: 16762346 DOI: 10.1016/j.fertnstert.2006.01.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 01/03/2006] [Accepted: 01/03/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the therapeutic effects of uterine artery ligation for pregnant women with uterine leiomyomas, who are undergoing cesarean section. DESIGN Prospective clinical study without randomization. SETTING University-affiliated tertiary referral center. PATIENT(S) Forty-eight women with uterine leiomyomas undergoing cesarean section for obstetric reasons were enrolled into the study. Diagnosis was established with ultrasound before or during early pregnancy. INTERVENTION(S) Ligation of the bilateral uterine arteries was performed immediately after closure of the uterine incision wound. MAIN OUTCOME MEASURE(S) Blood loss during cesarean section, dominant leiomyoma size, and future surgical intervention for symptomatic leiomyoma. RESULT(S) Twenty-six (54%) of 48 patients underwent uterine artery ligation during cesarean section (group I), and 22 (46%) received cesarean section only (group II). The average follow-up time was 38.5 months. The average blood loss during surgery was 254 +/- 92.3 mL for group I and 278 +/- 160.5 mL for group II. Hemoglobin on the first postoperative day was 11.2 +/- 0.9 g/dL for group I and 10.4 +/- 1.1 g/dL for group II. One patient in group II required blood transfusion due to hemorrhage. Two patients (7.7%) in group I and 9 (40.9%) in group II underwent myomectomy or hysterectomy for symptomatic leiomyomas within 6-38 months after cesarean section. Reductions in the dominant myoma size (average: 45%) were demonstrated in group I patients postoperatively. Four patients (15.4%) in group I and three (13.6%) in group II had a repeat cesarean section during the follow-up period. CONCLUSION(S) Uterine artery ligation appears to be a promising method for treating pregnant women with uterine leiomyomas, who are undergoing cesarean section, because it is able to reduce postpartum blood loss and minimize the necessity of future surgery. Fertility is apparently not compromised by this treatment, which offers obstetricians with another choice between observation and myomectomy for pregnant women with leiomyomas who are undergoing cesarean section.
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Affiliation(s)
- Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taipei, Taiwan.
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Affiliation(s)
- Farrokh Dehdashti
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Boulevard, St. Louis, MO 63110, USA
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Wang PH, Chao HT, Liu RS, Cho YH, Ng HT, Yuan CC. Diagnosis and localization of testosterone-producing ovarian tumors: imaging or biochemical evaluation. Gynecol Oncol 2001; 83:596-8. [PMID: 11733978 DOI: 10.1006/gyno.2001.6412] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In the testosterone-secreting ovarian tumor (TSOT), the role of whole-body positron emission tomography (WBPET) with (fluorine-18)-2-deoxyglucose scanning (FDG) and/or [(11)C]acetate is unclear, although it presents a rationale that these functional tumors would be more active and have increased use of glucose and oxygen consumption than normal tissues. CASE A 52-year-old woman had a history of steroid cell tumors of the right ovary (IIA) and she received staging surgery including total hysterectomy, salpingo-oophorectomy, and lymph node sampling. Reelevated serum levels of T (5.24 ng/ml) were noted 52 months later. The patient received serial preoperative examinations including WBPET with FDG and acetate, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) to evaluate her recurrence. A suspicious mass on the liver was found on ultrasound, CT, and MRI. The ultrasound-guided biopsy was performed three times, and each of them failed to provide any pathological confirmation. Functional imaging studies showed an abnormal uptake in WBPET using [(11)C]acetate but were negative using FDG. Because of the size of the tumor, the patient's hesitatancy toward an operation, and good previous response to gonadotropin-releasing hormone (GnRH) agonist treatment, the patient received a six-cycle GnRH agonist treatment. Serum T levels returned to normal limits after administration of the first dose of GnRH agonist. At follow-up, serum hormone levels were all within the normal ranges consistent with menopause, but the size of the metastatic tumor was constant. The tumor was then completely excised pathologically proven to be a metastatic TSOT. CONCLUSIONS Recurrent TSOT might be successfully detected using WBPET with [(11)C]acetate. In addition, GnRH agonist could be tried in patients with TSOT if initial responses were excellent and surgical intervention could not be performed.
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Affiliation(s)
- P H Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
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