Hypermetabolic Calcified Lymph Nodes on 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography in a Case of Treated Ovarian Cancer Recurrence: Residual Disease or Benign Formation?
05 Jun 2016-Molecular Imaging and Radionuclide Therapy (Mol Imaging Radionucl Ther)-Vol. 25, Iss: 2, pp 91-96
TL;DR: Both CT corrected and uncorrected PET images showed hypermetabolism in the massively calcified lymph nodes in the neck, mediastinum, axilla and abdomen, indicative of active residual disease.
Abstract: The contribution of positron emission tomography/computed tomography (PET/CT) with 18F-fludeoxyglucose (FDG) in evaluating ovarian cancer recurrence even after a prolonged disease-free interval, and in therapy response is well-described. Calcifications observed in CT, although usually attributed to benign conditions, may actually represent active disease. Such an example of calcified formations is psammoma bodies. We present a case of 56-y. o. patient with ovarian cancer relapse at the supraclavicular area 18 years after complete response and disease-free interval. The patient received chemotherapy and underwent 18F-FDG-PET/CT for the evaluation of treatment response. Both CT corrected and uncorrected PET images showed hypermetabolism in the massively calcified lymph nodes in the neck, mediastinum, axilla and abdomen, indicative of active residual disease.
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TL;DR: In this article, a case of serous papillary ovarian cancer with extensive abdomino-pelvic calcified metastases referred for evaluation of therapy response was evaluated using PET/computed tomography (PET/CT) images.
Abstract: Evaluation of calcified metastatic lesions by conventional imaging can be challenging. Ovarian cancer metastases can present with calcification which might increase in size and number following therapy. It is not entirely clear whether these calcifications are associated with tumor response or disease progression. Calcified lesions which do not change in size or configuration are particularly problematic when assessed by RECIST criteria. Positron emission tomography (PET)/computed tomography (CT) is of particular value as it demonstrates the metabolic activity of the calcified lesions, in addition, it might reveal metastases in unexpected sites. We report a case of serous papillary ovarian cancer with extensive abdomino-pelvic calcified metastases referred for evaluation of therapy response. Despite being reported as stable disease on CT evaluation, we observed increased metabolic activity in the calcified lesions both on CT-attenuation corrected and non-attenuation corrected images, which was indicative of inadequate response to therapy. PET/CT is an ideal modality in follow-up of patients with ovarian cancer presenting with calcified metastatic tumoral deposits.
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...This fact was emphasized in a case report by Nikaki et al (11)....
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TL;DR: An update is provided on the pathogenesis and clinicopathologic features of these 2 types of serous carcinomas and addresses some of the diagnostic problems that are encountered in routine practice.
Abstract: Ovarian serous carcinomas have been graded using various systems. Recently, a 2-tier system in which tumors are subdivided into low-grade and high-grade has been proposed. This approach is simplistic, reproducible, and based on biologic evidence indicating that both tumors develop via different pathways. Low-grade serous carcinomas exhibit low-grade nuclei with infrequent mitotic figures. They evolve from adenofibromas or borderline tumors, have frequent mutations of the KRAS, BRAF, or ERBB2 genes, and lack TP53 mutations (Type I pathway). The progression to invasive carcinoma is a slow step-wise process. Low-grade tumors are indolent and have better outcome than high-grade tumors. In contrast, high-grade serous carcinomas have high-grade nuclei and numerous mitotic figures. Identification of a precursor lesion in the ovary has been elusive and therefore the origin of ovarian carcinoma has been described as de novo. More recently, studies have suggested that a proportion appear to originate from intraepithelial carcinoma in the fallopian tube. The development of these tumors is rapid (Type II pathway). The vast majority are characterized by TP53 mutations and lack mutations of KRAS, BRAF, or ERBB2. Although both types of serous carcinomas evolve along different pathways, rare high-grade serous carcinomas seem to arise through the Type I pathway. Immunohistochemical stains for p53, p16, and Ki-67 for distinction of low- from high-grade tumors are of limited value but can be helpful in selected instances. This review provides an update on the pathogenesis and clinicopathologic features of these two types of serous carcinomas and addresses some of the diagnostic problems that are encountered in routine practice.
538 citations
"Hypermetabolic Calcified Lymph Node..." refers background in this paper
...Although the exact mechanism of psammoma body formation is yet unclear, they are known to be associated with increased apoptotic cell death, BRAF mutation, and normal TP53 function, all of which are more profound in low-grade ovarian serous adenocarcinoma (22,23,24)....
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TL;DR: The functional status of tumor ERs can be characterized in vivo by PET with FDG and FES, and the results of PET are predictive of responsiveness to tamoxifen therapy in patients with advanced ER(+) breast cancer.
Abstract: PURPOSE: The purpose of this study was to investigate whether positron emission tomography (PET) with the glucose analog [18F]fluorodeoxyglucose (FDG) and the estrogen analog 16 alpha-[18F]fluoroestradiol-17 beta (FES), performed before and after treatment with tamoxifen, could be used to detect hormone-induced changes in tumor metabolism (metabolic flare) and changes in available levels of estrogen receptor (ER). In addition, we investigated whether these PET findings would predict hormonally responsive breast cancer. PATIENTS AND METHODS: Forty women with biopsy-proved advanced ER-positive (ER+) breast cancer underwent PET with FDG and FES before and 7 to 10 days after initiation of tamoxifen therapy; 70 lesions were evaluated. Tumor FDG and FES uptake were assessed semiquantitatively by the standardized uptake value (SUV) method. The PET results were correlated with response to hormonal therapy. RESULTS: In the responders, the tumor FDG uptake increased after tamoxifen by 28.4% ± 23.3% (mean ± SD); onl...
371 citations
"Hypermetabolic Calcified Lymph Node..." refers background in this paper
...Increase in FDG uptake after treatment due to flare phenomenon, causing false positive results, has also been described after Tamoxifen or Bevacizumab therapy (17,18)....
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TL;DR: An increased number of estimated ovulatory cycles correlates directly with risk for both endometrial and ovarian cancer, suggesting that reproductive tissue turnover with an accumulation of PTEN or p53 mutations represents a possible common mechanism.
Abstract: The epidemiology of ovarian cancer and endometrial cancer is closely entwined. Agespecific incidence curves and the international rates for both sites parallel each other, and histologic subtypes of cancer arising from the endometrium mirror types found in the ovary. Most of the personal factors that increase or decrease risk for one of these cancers act in the same direction for the other. For these reasons, this article considers the epidemiology of ovarian and endometrial cancer together, with the goal of providing a more unified perspective. The author does not address the epidemiology of cervical cancer in this article, though this is not for lack of importance. Worldwide cervical cancer is a greater source of morbidity and mortality than endometrial and ovarian cancer combined (Table 1). However, there are far fewer epidemiologic uncertainties related to cervical cancer, and the means of its prevention and early detection are in hand, if not yet fully implemented where they are most needed. TUMOR HETEROGENEITY AS IT MAY AFFECT EPIDEMIOLOGIC ASSOCIATIONS Before discussing the epidemiology of endometrial and ovarian cancer, it must be pointed out that neither of these cancers is homogeneous from a histopathologic standpoint. Cancer registries often include endometrial cancer under the broader category “cancers of the uterine corpus,” which includes sarcomas that arise from the endometrial stroma or from the smooth muscle of the uterus. Adenocarcinomas comprise the vast majority of cancers of the uterine corpus, and most epidemiologic studies are restricted to these. In turn, endometrial adenocarcinomas may be further subdivided, with endometrioid (or Type I) cancers accounting for majority, about 85%, and the remainder designated Type II and including adenosquamous, serous papillary, clear cell, and undifferentiated types, similar to those found in the ovary. 1,2
182 citations
"Hypermetabolic Calcified Lymph Node..." refers background in this paper
...More indolent forms also exist that are no longer considered as malignant (2)....
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TL;DR: Ovarian cancer patients face an appreciable risk of recurrence in the first 5 years after second-look laparotomy with negative findings after platinum-based chemotherapy, but those who remain disease free at 5 years have excellent long-term survival rates.
178 citations
TL;DR: Integrated PET/contrast-enhanced CT is an accurate modality for assessing colorectal cancer recurrence and led to changes in the subsequent appropriate therapy.
Abstract: Purpose
The purpose of this study is to evaluate the accuracy of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) with intravenous contrast for depiction of recurrent pancreatic cancer, compared with PET/non-enhanced CT and CT.
137 citations