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Zhang J, Dong A, Wang Y. FDG PET/CT Findings of Primary Pulmonary Choriocarcinoma in a Postmenopausal Woman. Clin Nucl Med 2024; 49:698-700. [PMID: 38739485 DOI: 10.1097/rlu.0000000000005272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
ABSTRACT Choriocarcinomas usually occur in the genital tracts of reproductive-age women after a gestational event. Primary pulmonary choriocarcinoma is very rare. We describe FDG PET/CT findings of primary pulmonary choriocarcinoma with multiple intrapulmonary metastases in a postmenopausal woman with elevated serum beta human chorionic gonadotropin level. On FDG PET/CT, the large primary lung tumor showed intense FDG uptake (SUV max , 46), and the small intrapulmonary metastases showed variable FDG uptake (SUV max , 27). Primary pulmonary choriocarcinoma should be included in the differential diagnosis of FDG-avid pulmonary lesions with elevated serum beta human chorionic gonadotropin levels, including metastatic choriocarcinoma and lung cancer.
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Affiliation(s)
- Jun Zhang
- From the Department of Cardiothoracic Surgery, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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Huang W, Zheng Z, Bao Z, Xiao X, Li L, Sun Z, Kang L. A poor prognostic male choriocarcinoma with multiple systemic metastases: a case report and the literature review. Front Med (Lausanne) 2024; 11:1382672. [PMID: 38572155 PMCID: PMC10989191 DOI: 10.3389/fmed.2024.1382672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Background Non-gestational choriocarcinoma, also known as primary choriocarcinoma, is extremely rare in men, manifesting with specific signs such as breast feminization, testicular atrophy, and loss of libido. The presentation typically includes elevated serum β-hCG levels, widespread metastatic disease, and a rapid progression of the condition. Case report We present a rare case of a 41-year-old man diagnosed with choriocarcinoma, exhibiting a unique combination of multiple metastases, including lung, brain, bone, and retroperitoneal lymph node metastases, as confirmed by 18F-FDG PET/CT imaging. The patient was treated with aggressive chemotherapy and pembrolizumab, and the prognosis remained poor. The patient's overall survival was a mere 5 months following diagnosis. Conclusion Non-gestational choriocarcinoma represents a rare entity in clinical practice and should be considered in young men presenting with gynaecomastia and elevated β-hCG levels alongside normal gonads. Thus, we advocate for a more comprehensive inquiry into medical history and a systematic examination. The 18F-FDG PET/CT examination not only visually delineates the lesion's location and extent but also serves as a cornerstone for clinical tumor staging, providing valuable support for treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zuohuan Zheng
- Department of Traditional Chinese Medicine, The Seventh People’s Hospital of Chongqing, Chongqing, China
| | - Zheng Bao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyan Xiao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhaonan Sun
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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Bezzi C, Monaco L, Ghezzo S, Mathoux G, Bergamini A, Zambella E, Fallanca F, Samanes Gajate AM, Presotto L, Sabetta G, Mangili G, Cioffi R, Bettinardi V, Gianolli L, Mapelli P, Picchio M. 18F-FDG PET/CT May Predict Tumor Type and Risk Score in Gestational Trophoblastic Disease. Clin Nucl Med 2022; 47:525-531. [PMID: 35353763 DOI: 10.1097/rlu.0000000000004135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to investigate the role of 18F-FDG PET/CT in predicting pathological prognostic factors, including tumor type and International Federation of Gynecology and Obstetrics (FIGO) score, in gestational trophoblastic disease (GTD). METHODS Retrospective monocentric study including 24 consecutive patients who underwent to 18F-FDG PET/CT from May 2005 to March 2021 for GTD staging purpose. The following semiquantitative PET parameters were measured from the primary tumor and used for the analysis: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolisis (TLG). Statistical analysis included Spearman correlation coefficient to evaluate the correlations between imaging parameters and tumor type (nonmolar trophoblastic vs postmolar trophoblastic tumors) and risk groups (high vs low, defined according to the FIGO score), whereas area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to assess the predictive value of the PET parameters. Mann-Whitney U test was used to further describe the parameter's potential in differentiating the populations. RESULTS SUVmax and SUVmean resulted fair (AUC, 0.783; 95% confidence interval [CI], 0.56-0.95) and good (AUC, 0.811; 95% CI, 0.59-0.97) predictors of tumor type, respectively, showing a low (ρ = 0.489, adjusted P = 0.030) and moderate (ρ = 0.538, adjusted P = 0.027) correlation. According to FIGO score, TLG was instead a fair predictor (AUC, 0.770; 95% CI, 0.50-0.99) for patient risk stratification. CONCLUSIONS 18F-FDG PET parameters have a role in predicting GTD pathological prognostic factors, with SUVmax and SUVmean being predictive for tumor type and TLG for risk stratification.
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Affiliation(s)
| | | | | | | | | | | | - Federico Fallanca
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute
| | | | - Luca Presotto
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute
| | - Giulia Sabetta
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Mangili
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Cioffi
- Unit of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luigi Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute
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Abstract
Choriocarcinoma is a cancer that usually occurs in the uterus during pregnancy. Extragonadal choriocarcinoma, although very rare, can occur. The diagnostic dilatation and curettage of the uterus in a 28-year-old woman who had vaginal bleeding and elevated human chorionic gonadotrophin level failed to identify any abnormality. FDG PET/CT revealed abnormal activity in the head of the pancreas. Pathological examination after partial pancreatectomy demonstrated primary choriocarcinoma in the pancreas.
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Dhanda S, Ramani S, Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract 2014; 2014:842751. [PMID: 25126425 PMCID: PMC4122023 DOI: 10.1155/2014/842751] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/28/2014] [Indexed: 11/20/2022] Open
Abstract
Gestational trophoblastic disease is a condition of uncertain etiology, comprised of hydatiform mole (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. It arises from abnormal proliferation of trophoblastic tissue. Early diagnosis of gestational trophoblastic disease and its potential complications is important for timely and successful management of the condition with preservation of fertility. Initial diagnosis is based on a multimodality approach: encompassing clinical features, serial quantitative β-hCG titers, and pelvic ultrasonography. Pelvic magnetic resonance imaging (MRI) is sometimes used as a problem-solving tool to assess the depth of myometrial invasion and extrauterine disease spread in equivocal and complicated cases. Chest radiography, body computed tomography (CT), and brain MRI have been recommended as investigative tools for overall disease staging. Angiography has a role in management of disease complications and metastases. Efficacy of PET (positron emission tomography) and PET/CT in the evaluation of recurrent or metastatic disease has not been adequately investigated yet. This paper discusses the imaging features of gestational trophoblastic disease on various imaging modalities and the role of different imaging techniques in the diagnosis and management of this entity.
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Affiliation(s)
- Sunita Dhanda
- Department of Diagnostic Imaging, National University Hospital, Level 2, Main Building, 5 Lower Kent Ridge Road, Singapore 119074
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
| | - Subhash Ramani
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
| | - Meenkashi Thakur
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
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Mapelli P, Mangili G, Picchio M, Gentile C, Rabaiotti E, Giorgione V, Spinapolice EG, Gianolli L, Messa C, Candiani M. Role of 18F-FDG PET in the management of gestational trophoblastic neoplasia. Eur J Nucl Med Mol Imaging 2013; 40:505-13. [PMID: 23314259 DOI: 10.1007/s00259-012-2324-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/10/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Gestational trophoblastic neoplasia (GTN) is a rare and aggressive tumour that is usually sensitive to chemotherapy. The usefulness of conventional imaging modalities in evaluating treatment response is limited, mainly due to the difficulty in differentiating between residual tumour tissue and necrosis. The aim of the present study was to evaluate the role of FDG PET or PET/CT in primary staging and in monitoring treatment efficacy. The effect of FDG PET and combined PET/CT on the management of patients with GTN was also evaluated comparing the differences between standard treatments based on conventional imaging and alternative treatments based on PET. METHODS This retrospective study included 41 patients with GTN referred to San Raffaele Hospital between 2002 and 2010. All patients were studied by either PET or PET/CT in addition to conventional imaging. Of the 41 patients, 38 were evaluated for primary staging of GTN and 3 patients for chemotherapy resistance after first-line chemotherapy performed in other Institutions. To validate the PET data, PET and PET/CT findings were compared with those from conventional imaging, including transvaginal ultrasonography (TV-US) in those with uterine disease, CT and chest plain radiography in those with lung disease and whole-body CT in those with systemic metastases. Conventional imaging was considered positive for the presence of uterine disease and/or metastases when abnormal findings relating to GTN were reported. PET and PET/CT were considered concordant with conventional imaging when metabolic active disease was detected at the sites corresponding to the pathological findings on conventional imaging. In addition, in 12 of the 41 patients showing extrauterine disease, FDG PET/CT was repeated to monitor treatment efficacy, in 8 after normalization of beta human chorionic gonadotropin (βHCG) and in 4 with βHCG resistance. In some patients, PET or PET/CT findings led to an alternative nonconventional treatment, and this was considered a change in patient management for the study analysis. RESULTS When compared to TV-US, chest radiography and CT for staging, PET showed a concordance in 91 %, 84 % and 81 % of patients, respectively. In 8 of the 41 patients with extrauterine disease during staging, PET/CT showed a complete response to therapy after βHCG normalization. PET and PET/CT identified the sites of persistent disease in all seven high-risk patients with βHCG resistance, of whom four underwent second-line chemotherapy, two surgical removal of resistant disease instead of additional chemotherapy, and one surgical removal of resistant disease and second-line chemotherapy with subsequent negative βHCG. CONCLUSION In staging, PET cannot replace conventional imaging and does not show any information in addition to that shown by conventional imaging. The additional value of PET/CT in GTN with respect to conventional imaging is found in patients with high-risk disease. PET can identify the sites of primary and/or metastatic disease in patients with persistent high levels of βHCG after first-line chemotherapy and may be of additional value in patient management for guiding alternative treatment.
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Affiliation(s)
- P Mapelli
- Department of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
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8
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A case of pulmonary choriocarcinoma metastasis with unusual FDG-PET and CT findings: correlation with pathology. Ann Nucl Med 2012; 26:835-9. [DOI: 10.1007/s12149-012-0644-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
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Kara T, Ozcan Kara P, Baba F, Celik C, Kara Gedik G. Primary epithelioid trophoblastic tumor with a synchronous breast carcinoma detected only with FDG-PET/CT Scan. ACTA ACUST UNITED AC 2011; 30:368-71. [PMID: 21440960 DOI: 10.1016/j.remn.2010.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 10/15/2010] [Accepted: 10/15/2010] [Indexed: 11/19/2022]
Abstract
Epithelioid trophoblastic tumor is a recently described, rare and distinctive type of gestational trophoblastic tumor. We report the case of a 31-year old patient who had a full-term pregnancy 18 months before presentation. She had a right axillary lymph node metastasis and was referred for FDG-PET/CT scan for evaluation of distant metastasis and to detect primary malignancy. The axillary lymph node biopsy revealed metastatic breast carcinoma. FDG-PET/CT revealed increased uptake of right axillary lymph node, soft tissue density lesion with a diameter of 24 mm on left cervical region with increased FDG uptake, increased uptake on cervical region and left inguinal lymph node with increased uptake. Pelvic MRI imaging and ultrasonography were negative for malignancy in cervical region. Biopsy of the lesion was consistent with epithelioid trophoblastic tumor in cervical region. Gestational trophoblastic tumor was not suspected because she had no signs such as abnormal vaginal bleeding. FDG-PET/CT demonstrated the primary lesion in cervical region. We report a rare case of primary epithelioid trophoblastic tumor detected only with FDG-PET/CT scan which synchronized with breast carcinoma.
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Affiliation(s)
- T Kara
- Department of Radiology, Beyhekim Hospital, Selcuklu, Konya, Turkey.
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Yen TC, Chuang CK, Lai CH. Lower Genitourinary Tract. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bachmann J, Ernestus K, Werner T, Garnier Y, Mallmann P, Pietsch C, Schicha H, Schmidt M. Detection of primary choriocarcinoma in the mediastinum by F-18 FDG positron emission tomography. Clin Nucl Med 2007; 32:663-5. [PMID: 17667449 DOI: 10.1097/rlu.0b013e3180a1ac9d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 31-year-old woman with a history of infection with human papilloma virus was found to have an elevated human chorionic gonadotropin level (beta-HCG) of more than 9000 IU/L in January 2006. The patient reported an irregular menstrual cycle. Extensive clinical work-up including gynecologic examinations with laparoscopy, hysteroscopy, and curettage were performed but no pathologic explanation of this elevated beta-HCG could be found. In the initial computed tomography (CT) of the abdomen and the thorax, a tumor could not be detected. Based on a clinical decision, chemotherapy with methotrexate in a dose of 1 mg/kg body weight was started. Four months after beginning of the chemotherapy the beta-HCG level dropped to 3048 IU/L. At this time a first F-18 FDG PET was performed and the findings were negative. After completion of 7 cycles of chemotherapy the beta-HCG level rose again. In a second F-18 FDG PET in August 2006 focal, intense and pathologic F-18 FDG accumulation with a SUV max. of 5.4 was seen in the mediastinum in the region of the thymus. At this time the beta-HCG level was 7000 IU/L. In a subsequent CT of the chest a retrosternal mass of 4 x 1.7 cm was detected with contrast enhancement. Resection of the tumor and thymus gland demonstrated a choriocarcinoma in part adjacent to the thymus and in part in the thymus. Postoperative beta-HCG levels dropped to 105 IU/L.
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Affiliation(s)
- Juliane Bachmann
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
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Abstract
Most positron emission tomography (PET) imaging studies in gynecologic cancer are performed using (18)F-fluorodeoxyglucose (FDG). It contributes valuable information in primary staging of untreated advanced cervical cancer, in the post-treatment surveillance with unexplained tumor marker (such as squamous cell carcinoma antigen [SCC-Ag]) elevation or suspicious of recurrence, and restaging of potentially curable recurrent cervical cancer. Its value in early-stage resectable cervical cancer is questionable. In ovarian cancer, FDG-PET provides benefits for those with plateaued or increasing abnormal serum CA 125 (>35 U/mL), computed tomography and/or magnetic resonance imaging (CT-MRI) defined localized recurrence feasible for local destructive procedures (such as surgery, radiotherapy, or radiofrequency ablation), and clinically suspected recurrent or persistent cancer for which CT-guide biopsy cannot be performed. The role of FDG-PET in endometrial cancer is relatively less defined because of the lack of data in the literature. In our prospective study, FDG-PET coupled with MRI-CT may facilitate optimal management of endometrial cancer in well-selected cases. The clinical impact was positive in 29 (48.3%) of the 60 scans, 22.2% for primary staging, 73.1% for post-therapy surveillance, and 57.1% after salvage therapy, respectively. Scant studies have been reported in the management of vulvar cancer using FDG-PET. More data are needed. Gestational trophoblastic neoplasia is quite unique in biological behavior and clinical management. Our preliminary results suggest that FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by providing a precise metastatic mapping of tumor extent up front, monitoring response, and localizing viable tumors after chemotherapy. The evaluation of a diagnostic tool, such as PET, is usually via comparing the diagnostic efficacy (sensitivity, specificity, etc), by using a more sophisticated receiver operating curve method, or the proportion of treatment been modified. Evaluating PET by clinical benefit is specific to the individual tumor and an attractive new endpoint.
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Affiliation(s)
- Tzu-Chen Yen
- Department of Nuclear Medicine, Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Shaw SW, Wang CW, Ma SY, Ng KK, Chang TC. Exclusion of lung metastases in placental site trophoblastic tumor using [18F]fluorodeoxyglucose positron emission tomography: a case report. Gynecol Oncol 2005; 99:239-42. [PMID: 16051337 DOI: 10.1016/j.ygyno.2005.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 05/18/2005] [Accepted: 06/01/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND We present the first case using [18F]fluorodeoxyglucose positron emission tomography (PET) for the evaluation of multiple lung nodules in a woman with placental site trophoblastic tumor (PSTT) and history of pulmonary tuberculosis. CASE PSTT was diagnosed by endometrial biopsy in a 38-year-old female, 11 months after an abortion. She had received medical treatment for pulmonary tuberculosis 8 years ago. Nodular lung lesions in upper and lower lung fields were noted on the chest X-ray and computed tomography, which was not shown on PET. She then received hysterectomy and complete remission of serum beta-hCG titer with stationary lung lesions in follow-up images were noticed thereafter. CONCLUSION PET, as adjuvant study to conventional images, may help in the differentiation of chest lesions in PSTT.
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Affiliation(s)
- Sheng-Wen Shaw
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan
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Chang TC, Yen TC, Li YT, Wu YC, Chang YC, Ng KK, Jung SM, Wu TI, Lai CH. The role of 18F-fluorodeoxyglucose positron emission tomography in gestational trophoblastic tumours: a pilot study. Eur J Nucl Med Mol Imaging 2005; 33:156-63. [PMID: 16220307 DOI: 10.1007/s00259-005-1873-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 05/22/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We conducted a pilot trial to evaluate the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in gestational trophoblastic tumours (GTTs). METHODS Patients with placental site trophoblastic tumour (PSTT), high-risk GTT (World Health Organisation score > or =8, disease onset at postpartum or greater than 6 months after antecedent pregnancy), metastatic GTT, recurrent/resistant GTT after chemotherapy, or post-molar GTT with unexplained abnormal beta-hCG regression and patients undergoing re-evaluation after salvage treatment were enrolled. PET was undertaken within 1 week after computed tomography (CT). Clinical impacts of additional PET were determined on a scan basis. RESULTS A total of 14 patients were recruited. Sixteen PET scans were performed, with one patient having three serial studies. Benefits of additional PET were seen in 7 of 16 (43.8%) scans; these benefits included disclosure of chemotherapy-resistant lesions (n = 2), exclusion of false-positive CT lesions (n = 1), detection of an additional lesion not found by conventional imaging (n = 1) in high-risk GTT at the start of primary chemotherapy, and confirmation of complete response to treatment for PSTT or to salvage therapy for recurrent/resistant GTT (n = 3). On the other hand, in two instances there were false-negative PET findings, six scans yielded no benefit, and one showed an indeterminate lesion. CONCLUSION Our preliminary results suggest that 18F-FDG PET is potentially useful in selected patients with GTT by providing precise mapping of metastases and tumour extent upfront, by monitoring treatment response and by localising viable tumours after chemotherapy. A larger study is necessary to further define the role of 18F-FDG PET in GTT.
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Affiliation(s)
- Ting Chang Chang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Numnum TM, Leath CA, Straughn JM, Conner MG, Barnes MN. Occult choriocarcinoma discovered by positron emission tomography/computed tomography imaging following a successful pregnancy. Gynecol Oncol 2005; 97:713-5. [PMID: 15863190 DOI: 10.1016/j.ygyno.2005.01.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Revised: 01/13/2005] [Accepted: 01/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Positron emission tomography (PET) is commonly used to detect occult or recurrent malignancy, including tumors of the female genital tract. Recently, there have been reports of PET scans used in patients with Gestational Trophoblastic Disease (GTD). CASE A 22-year-old female presented with vaginal bleeding and elevated beta-hCG 7 months after a spontaneous vaginal delivery of a healthy infant. She had a history of molar pregnancy and persistent GTD requiring multi-agent chemotherapy. Metastatic evaluation with computed tomography and magnetic resonance imaging showed no evidence of GTD. A positron emission tomography/computed tomography (PET/CT) scan revealed a focus of metabolic activity in the left pelvis. The patient underwent an exploratory laparotomy that revealed metastatic choriocarcinoma in the left broad ligament. CONCLUSION PET/CT may be useful in the evaluation of occult choriocarcinoma when conventional imaging fails to identify metastatic disease.
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Affiliation(s)
- T Michael Numnum
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, OHB 340, Birmingham, AL 35294, USA.
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Joshua AM, Carter JR, Beale P. The use of taxanes in choriocarcinoma; a case report and review of the literature. Gynecol Oncol 2004; 94:581-3. [PMID: 15297209 DOI: 10.1016/j.ygyno.2004.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Both preclinical data and case reports support the use of taxanes for high-risk metastatic choriocarcinoma. CASE We report the case of a 31-year-old with metastatic choriocarcinoma who required 3rd-line treatment with a paclitaxel-cisplatin-based regimen. She achieved a complete response and remains relapse-free 21 months after her last dose of chemotherapy. CONCLUSION The literature suggests that paclitaxel contributes significantly to the treatment of choriocarcinoma and its use should be explored further. This is the first case report formally reporting its combination with cisplatin.
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Affiliation(s)
- A M Joshua
- Department of Medical Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Campderdown 2050, Sydney, Australia
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Sironi S, Picchio M, Mangili G, Garavaglia E, Zangheri B, Messa C, Voci C, Taccagni GL, del Maschio A, Fazio F. [18f]fluorodeoxyglucose positron emission tomography as a useful indicator of metastatic gestational trophoblastic tumor: preliminary results in three patients. Gynecol Oncol 2003; 91:226-30. [PMID: 14529686 DOI: 10.1016/s0090-8258(03)00437-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the usefulness of positron emission tomography with [(18)F]fluorodeoxyglucose ([(18)F]FDG-PET) in detecting metastases in patients with gestational trophoblastic tumor (GTTs). METHODS A retrospective study was conducted on three patients with GTTs who had been studied with [(18)F]FDG-PET and computed tomography (CT) after an increase in human chorionic beta-gonadotropin (betahCG) serum levels. PET scans were performed with a multiring whole-body positron emission tomograph 45 min after an intravenous bolus injection of [(18)F]FDG ( approximately 5.2 MBq/kg). CT studies were obtained on a spiral scanner prior and after administration of intravenous iodinated contrast material. Within a week of CT and [(18)F]FDG-PET studies, the patients underwent surgical procedures for histological diagnosis. RESULTS In one patient, a lung lesion positive for neoplastic tissue with [(18)F]FDG-PET and negative with CT was confirmed to be a GTT metastasis at histology. In another patient, [(18)F]FDG-PET was negative, while CT was positive for the presence of lung metastasis; no viable tumor tissue was found at histological analysis. The remaining patient had a positive [(18)F]FDG-PET and CT study for lung metastasis; this was confirmed at histological analysis. In the same patient, both [(18)F]FDG-PET and CT depicted the presence of a liver lesion. Necrotic lesion regression after treatment was clearly documented with [(18)F]FDG-PET only. CONCLUSIONS Our preliminary results suggest that [(18)F]FDG-PET may be useful for the assessment of metastatic disease in patients with GTTs.
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Affiliation(s)
- S Sironi
- University of Milano-Bicocca, Milan, Italy.
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