Page 4 - Jcog-October 2016
P. 4
Journal of Cases in Figure 1.
Ob s te tri cs & G yn e co l o g y
A 18F-FDG PET/CT scan (Biograph 2, Siemens, Ger-
demonstrated the presence of an ovarian dysgerminoma many) was performed after the injection of 344 MBq (9.3
with positive findings of immunohistochemistry (positive mCi) of 18F-FDG with a blood glucose level of 94 mg/
of CD17 and negative of CK, vimentin, CD30, AFP, EMA, dl for left lower quadrant abdominal pain with palpable
NSE) and the patient was addressed to chemotherapy. mass. The MIP and fusion axial (a, b) showing a huge
heterogenous increased FDG uptake of the mass arising
Discussion from the right ovary with a maximum standardized uptake
value (SUVmax) of 14.3, which suggest a malignancy
Ovarian dysgerminoma are rare ovarian tu- of ovary. Axial and coronal contrast enhanced abdom-
inopelvic CT (c, e) and axial and coronal T2-weighted
mors that occurs predominantly in young wom- pelvic dynamic MRI (d, f) images show a T2 intermediate
en in the second and third decades of life. They arise to high SI lobulating contoured mainly solid mass within
from the undifferentiated primordial germ cells [1]. fibrovascular septa and multifocal cystic lesion arising
Ovarydysgerminomashouldbedifferentiatedfromnon-ovar- from the right ovary.
ian malignant tumors, epithelial malignancy and other germ
cell tumors in ovary. Epithelial cystadenocarcinoma, the most
common tumor of ovary, often appearances as a cystic-solid
mass without envelope [2]. Elevated levels of β-hCG can
help confirm the diagnosis in about 5% of dysgerminoma.
Characteristic imaging findings include multilobulat-
ed solid masses with prominent fibrovascular septa. The
anechoic, low signal-intensity, or low-attenuation area
of the tumor represents necrosis and hemorrhage [3].
A few cases of ovarian dysgerminoma using 18F-FDG
PET/CT have been reported in the literature [4]. This
case shows a more huge, older age, high SUVmax and
β-hCG level in comparison with above-mentioned report.
A 18F-FDG PET/CT was useful in evaluating a malig-
nant potential of the ovary in an older woman with lower
quadrant abdominal pain or palpable mass and detection
of distant metastasis for operability. Although rare, dys-
germinoma should be considered one of the differential di-
agnosis of ovarian lesions detected by 18F-FDG PET/CT.
Acknowledgement
I thank Dr. S.Y. Jeong for providing writing and his helpful discussion.
Conflict of Interest Statement
Jae Pil Hwang declare that “I have no conflict of interest”.
References
1. Cushing B, Perlman EJ, Marina NM. Germ Cell an dysgerminoma. Chinese-German Jour- 4. Chih-Hsiang Yangl, Yen-Kung Chenz, Su-Mei
Tumors. In: Pizzo PA, Poplack DG (eds). Princi- nal of Clinical Oncology. 2008;7:735–7. Chenl, Chun-Cheng Chu. Ovarian Dysgerminoma
ples and Practice of Pediatric Oncology. Phil- 3. Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT Demonstrated by FDG PET/CT. Annals of Nucle-
adelphia, Lippincott Williams Wilkins 2002. and MR imaging of ovarian tumors with emphasis on ar Medicine and Molecular Imaging. 2012;25:33-5.
2. Xiaoping Yu. CT characteristics of ovari- differential diagnosis. Radiographics. 2002;22:1305-25.
114 October 2016
www.jcasesobstetgynecol.com
Ob s te tri cs & G yn e co l o g y
A 18F-FDG PET/CT scan (Biograph 2, Siemens, Ger-
demonstrated the presence of an ovarian dysgerminoma many) was performed after the injection of 344 MBq (9.3
with positive findings of immunohistochemistry (positive mCi) of 18F-FDG with a blood glucose level of 94 mg/
of CD17 and negative of CK, vimentin, CD30, AFP, EMA, dl for left lower quadrant abdominal pain with palpable
NSE) and the patient was addressed to chemotherapy. mass. The MIP and fusion axial (a, b) showing a huge
heterogenous increased FDG uptake of the mass arising
Discussion from the right ovary with a maximum standardized uptake
value (SUVmax) of 14.3, which suggest a malignancy
Ovarian dysgerminoma are rare ovarian tu- of ovary. Axial and coronal contrast enhanced abdom-
inopelvic CT (c, e) and axial and coronal T2-weighted
mors that occurs predominantly in young wom- pelvic dynamic MRI (d, f) images show a T2 intermediate
en in the second and third decades of life. They arise to high SI lobulating contoured mainly solid mass within
from the undifferentiated primordial germ cells [1]. fibrovascular septa and multifocal cystic lesion arising
Ovarydysgerminomashouldbedifferentiatedfromnon-ovar- from the right ovary.
ian malignant tumors, epithelial malignancy and other germ
cell tumors in ovary. Epithelial cystadenocarcinoma, the most
common tumor of ovary, often appearances as a cystic-solid
mass without envelope [2]. Elevated levels of β-hCG can
help confirm the diagnosis in about 5% of dysgerminoma.
Characteristic imaging findings include multilobulat-
ed solid masses with prominent fibrovascular septa. The
anechoic, low signal-intensity, or low-attenuation area
of the tumor represents necrosis and hemorrhage [3].
A few cases of ovarian dysgerminoma using 18F-FDG
PET/CT have been reported in the literature [4]. This
case shows a more huge, older age, high SUVmax and
β-hCG level in comparison with above-mentioned report.
A 18F-FDG PET/CT was useful in evaluating a malig-
nant potential of the ovary in an older woman with lower
quadrant abdominal pain or palpable mass and detection
of distant metastasis for operability. Although rare, dys-
germinoma should be considered one of the differential di-
agnosis of ovarian lesions detected by 18F-FDG PET/CT.
Acknowledgement
I thank Dr. S.Y. Jeong for providing writing and his helpful discussion.
Conflict of Interest Statement
Jae Pil Hwang declare that “I have no conflict of interest”.
References
1. Cushing B, Perlman EJ, Marina NM. Germ Cell an dysgerminoma. Chinese-German Jour- 4. Chih-Hsiang Yangl, Yen-Kung Chenz, Su-Mei
Tumors. In: Pizzo PA, Poplack DG (eds). Princi- nal of Clinical Oncology. 2008;7:735–7. Chenl, Chun-Cheng Chu. Ovarian Dysgerminoma
ples and Practice of Pediatric Oncology. Phil- 3. Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT Demonstrated by FDG PET/CT. Annals of Nucle-
adelphia, Lippincott Williams Wilkins 2002. and MR imaging of ovarian tumors with emphasis on ar Medicine and Molecular Imaging. 2012;25:33-5.
2. Xiaoping Yu. CT characteristics of ovari- differential diagnosis. Radiographics. 2002;22:1305-25.
114 October 2016
www.jcasesobstetgynecol.com
