J Gynecol Oncol.  2012 Jan;23(1):65-68. 10.3802/jgo.2012.23.1.65.

Complete biologic response to taxane based chemotherapy confirmed by [18F]FDG PET/CT and surgery in a cancer of unknown primary site

• Hwang JE
• Yoon JY
• Bae WK
• Shim HJ
• Chung IJ

• KMID: 2177516
• DOI: http://doi.org/10.3802/jgo.2012.23.1.65

Abstract

Cancers of an unknown primary site are heterogenous with respect to their clinical and pathologic features. They are generally very aggressive, but specific favorable subsets have a better prognosis. For these favorable subsets, taxane based chemotherapy is very effective for a subset of woman with papillary serous peritoneal adenocarcinoma. A 52 year-old woman underwent [18F]-FDG PET/CT for routine health screening. On PET/CT, multiple hypermetabolic lymph nodes were detected in the paraaortic spaces, and there were no other hypermetabolic abnormalities. The patient was diagnosed with an unknown primary cancer that probably originated from the ovary or peritoneum, according to clinical studies and biopsy results. This was not a typical case of a favorable subset of cancer of an unknown primary site, but the tumor showed complete biologic response to taxane based chemotherapy as revealed by PET/CT, and necrotic tumor cells were confirmed by surgery.

Keyword

Chemotherapy; Positron emission tomography; Taxane; Unknown primary neoplasms

MeSH Terms

Adenocarcinoma
Biopsy
Bridged Compounds
Female
Humans
Lymph Nodes
Mass Screening
Neoplasms, Unknown Primary
Ovary
Peritoneum
Positron-Emission Tomography
Prognosis
Taxoids
Bridged Compounds
Taxoids

Figure

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  Fig. 1 (A) The [18F]FDG PET/CT showed multiple conglomerated hypermetabolic lymph nodes encasing the inferior vena cava and abdominal aorta in the retrocaval, portocaval and paraaortic spaces. (B) The preoperative [18F]FDG PET/CT revealed that there were no hypermetabolic lesions in the remnant lymph nodes.

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  Fig. 2 (A) The initial CT showed huge intraabdominal lymph nodes encasing the inferior vena cava and abdominal aorta. (B) The follow-up CT after 6 cycles of taxane based chemotherapy showed a marked partial response according to the RECIST criteria.

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  Fig. 3 (A) The laparoscopic biopsy results showed the tumor cells that have pleomorphic nuclei and small cytoplasm (H&E, ×100). (B) The immunohistochemical staining results showed the tumor cells were positive for Wilm's tumor-1. (C) The operative biopsy results showed only extensive necrosis in the remnant lymph nodes without tumor cells (H&E, ×10).

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