Erdem SÜRÜCÜ, Sadet AYHAN, Gamze KAYA ÇAPA, Hatice DURAK

A case of ıncreased f-18 fdg uptake in uterine cavity due to diagnostic curettage

Endometrium kanseri kadınlarda en çok görülen malign tümörlerden birisidir. Erken teşhis edildiğinde tam tedavi şansı yüksektir ve prognozu çok iyi seyirlidir. Bölümümüzde endometrium kanseri ile ilgili olarak devam eden bir proje kapsamında, serum CA-125 yüksekliği ile endometrium kanseri şüphesi olan 53 yaşında kadın hasta bölümümüze refere edildi. PET görüntülerinde uterusda artmış F-18 FDG tutulumu izlenmiştir. Bu bulgunun hastanın öyküsünde 10 gün önce geçirilmiş diagnostik küretaja bağlı benign inflamatuar değişiklikler veya hemoraji ile ilgili olduğu düşünülmüştür. Bu olgu sunumunda diagnostik küretaja sekonder olduğu düşünülen F-18 FDG tutulumu muhtemelen literatürde ilk kez gösterilmektedir.

Uterusta dıagnostık küretaja sekonder artmış f-18 fdg tutulumu olgusu

Endometrial cancer is one of the most common malignant tumors of the women, and if it can be detected in the earlier stages, the curability and the prognosis of the endometrial cancers can be better. A 52 year-old female patient, as part of ongoing research project in our clinic on endometrial carcinoma, was referred to our clinic with a suspicion of endometrial carcinoma with increased serum CA-125 measurement. Increased F-18 FDG uptake in uterine cavity that was secondary to the diagnostic curettage was demonstrated on F 18 FDG PET images. This uptake might be secondary to benign inflammatory changes or hemorrhage arising from diagnostic curettage that patient underwent ten days ago. According to our knowledge, this is the first case demonstrating increased F-18 FDG uptake secondary to diagnostic curettage.

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1. Irvin WP, Rice LW, Berkowitz RS. Advances in the management of endometrial adenocarcinoma. A review. J Reprod Med 2002; 47: 173-189.
2. Nakamoto Y, Eisbruch A, Achtes ED, et al. Prognostic value of positron emission tomography using F-18- fluorodeoxylucose in patients with cervical cancer undergoing radiotherapy. Gynecol Oncol 2002;84:289-295.
3. Rose PG, Adler LB, Rodriguez M, Faulhaber PF, Abdul- Karim FW, Miraldi F. Positron emission tomography for evaluating paraaortic lymph node metastases in locally advanced cervical cancer before surgical staging: a surgico- pathologic study. J Clin Oncol 1999;17:41-44.
4. Reinhardt MJ, Ehritt-Braun C, Vogelgesang D, et al. Metastatic lymph nodes in patients with cervical cancer: detection with MR imaging and FDG PET. Radiology 2001;218: 776-782.
5. Grisby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol 2001; 19: 2745- 3749.
6. Miller TR, Grisby PW. Measurement of tumor volume by PET to evaluate prognosis in patients with advanced cervical cancer treated by radiation therapy. Int J Oncol Biol Phys 2002; 53: 353–359.
7. Zimny M, Siggelkow W, Schröder W, et al. 2-[Fluorine- 18]-fluoro-2-deoxy-Dglucose positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol 2001;83:310–315.
8. Liu Y. Benign ovarian and endometrial uptake on FDG PET-CT: patterns and pitfalls. Ann Nucl Med 2009; 23: 107-112.
9. Julian A, Payoux P, Rimailho J, Paynot N, Esquerre J. Uterine Uptake of F–18 FDG on Positron Emission Tomography Induced by an Intrauterine Device: Unusual Pitfall. Clin Nucl Med 2007; 32:128–129.
10. Chander S, Meltzer CC, and McCook BM. Physiologic uterine uptake of FDG during menstruation demonstrated with serial combined positron emission tomography and computed tomography. Clin Nucl Med 2002; 27:22–24.
11. Duk JM, Aalders JG, Fleuren GJ, de Bruijn HW. CA 125 a useful marker in endometrial carcinoma. Am J Obstet Gynecol 1986; 155:1097–1102.
12. Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000; 182:1328–1334.
13. Torizuka T, Kanno T, Futatsubashi M, et al. Imaging of gynecologic tumors: comparison of 11C-choline PET with 18F-FDG PET. J Nucl Med 2003; 44:1051–1056.
14. Belhocine T, de Barsy C, Hustinx R, et al. Usefulness of (18)F-FDG PET in the posttherapy surveillance of endometrial carcinoma. Eur J Nucl Med Mol Imaging 2002; 29: 1132–1139.
15. Horowitz NS, Dehdashti F, Herzog TJ, et al. Prospective evaluation of FDG-PET for detecting pelvic and paraaortic lymph node metastasis in uterine corpus cancer. Gynecol Oncol 2004; 101:164–171.
16. Chao A, Chang YC, Hsueh S, et al. F–18 fluorodeoxyglucose positron emission tomography in the management of endometrial cancer. Eur J Nucl Med 2006; 33: 36–44.
17. Belhocine T, de Barsy C, Hustinx R, et al. Usefulness of (18) F-FDG PET in the posttherapy surveillance of endometrial carcinoma. Eur J Nucl Med Mol Imaging 2002; 29:1132–1139.
18. Saga T, Higashi T, Ishimori T, et al. Clinical value of FDG-PET in the follow up of postoperative patients with endometrial cancer. Ann Nucl Med 2003; 17:197-203.
19. Imperiale A, Federici L, Lefebvre N, et al. F–18 FDG PET/CT as a valuable imaging tool for assessing treatment efficacy in inflammatory and infectious diseases. Clin Nucl Med 2010; 35: 86-90.
20. Kao PF, Chou YH, Lai CW. Diffuse FDG uptake in acute prostatitis. Clin Nucl Med 2008; 33:308-310.
21. Koff SG, Sterbis JR, Davison JM, Montilla-Soler JL. A unique presentation of appendicitis: F-18 FDG PET/CT. Clin Nucl Med 2006; 31:704-706.