Ovarian mass mimicking malignancy: a case report.

Area of Science:

• Nuclear Medicine
• Oncology
• Gynecology

Background:

• Positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose (FDG) is crucial for cancer staging.
• Hypermetabolism on FDG PET/CT typically indicates malignancy, but inflammatory processes can also cause increased uptake.
• Distinguishing between malignancy and inflammation in pelvic masses can be challenging.

Purpose of the Study:

• To report a case where FDG PET/CT findings suggestive of ovarian cancer with retroperitoneal metastasis were ultimately diagnosed as tubo-ovarian abscesses.
• To emphasize the potential for inflammatory conditions to mimic malignant imaging features.

Main Methods:

• A 32-year-old female presented with abdominal pain and pelvic mass lesions.
• Diagnostic workup included FDG PET/CT.
• Histopathological examination was performed for definitive diagnosis.

Main Results:

• FDG PET/CT revealed cystic mass lesions in bilateral ovaries with wall thickening and intense rim hypermetabolism.
• Multifocal hypermetabolic lymphadenopathies were observed in the left paraaortic, aortocaval, and common iliac lymph nodes.
• Histopathology confirmed tubo-ovarian abscesses, not ovarian cancer.

Conclusions:

• Intense FDG uptake in ovarian lesions and associated retroperitoneal lymphadenopathies can be caused by inflammatory conditions like tubo-ovarian abscesses.
• FDG PET/CT findings must be correlated with clinical and histopathological data to avoid misdiagnosis of malignancy.
• This case underscores the importance of considering inflammatory mimics in the differential diagnosis of hypermetabolic pelvic masses.