FDG avid uterine fibroid

Case contributed by Dalia Ibrahim

Presentation

Enlarged cervical lymph nodes.

Patient Data

Age: 35 years
Gender: Female

PET-CT

ct

Low-grade FDG uptake by a few mildly enlarged deep cervical lymph nodes, possibly inflammatory.

FDG avid right uterine body intensely enhancing lesion, likely fibroid. For better MRI assessment.

No other metabolically active lesions were distinctive for neoplasia.

mri

The uterus shows about three interstitial fibroids, the largest on the right uterine body. They elicit an isointense signal on T1 and a low signal on T2 and STIR weighted images. No diffusion restriction. The right large uterine fibroid shows adjacent prominent vessels.

Right ovarian small corpus luteum cyst.

No ovarian cystic or solid masses.

Photo

The photo illustrates FDG avid uterine fibroid.

Case Discussion

PET-CT was negative for malignancy. The patient had cervical lymph nodes biopsy which revealed an inflammatory process. No malignancy.

However, the FDG uptake by the uterine fibroid indicated an MRI assessment for better delineation. MRI confirmed typical features of uterine fibroid.

FDG uptake by uterine fibroids is variable. The mechanism of FDG uptake by uterine fibroid is not clear but may depend on hormones, tumor cell proliferation, microvascular density, expression of growth factors, and the existence of endometrial or inflammatory cells 1.

FDG avid fibroids are more common in premenopausal women (mainly around 40 years of age) than in postmenopausal women, this is likely secondary to cell richness and estrogen dependence of fibroids 2

Also, FDG uptake is likely to be higher in the proliferation period of the menstrual cycle than in other periods of the menstrual cycle 3.

FDG avid uterine fibroids in postmenopausal women,  malignancy should be considered 3

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