Translate this page into:
Ovarian Cancer Recurrence After 7 Years Presenting as Ovarian Vein Tumour Thrombosis Detected with Fluorine-18 Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.
*Corresponding author: Dr. Koramadai Karuppusamy Kamaleshwaran, Department of Nuclear Medicine, PET/CT and Radionuclide Therapy, Comprehensive Cancer Care Centre, Kovai Medical Centre and Hospital Limited, Coimbatore, 641014, Tamil Nadu, India.dr.kamaleshwar@gmail.com
-
Received: ,
Accepted: ,
How to cite this article: Kamaleshwaran KK, Elumalai R, Subbian A. Ovarian Cancer Recurrence After 7 Years Presenting as Ovarian Vein Tumour Thrombosis Detected with Fluorine-18 Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography. Indian J Nucl Med. 2026;41:598-9. doi: 10.25259/IJNM_199_25
Abstract
Venous thromboembolism is a major cause of morbidity and mortality in cancer patients. Up to 20% of patients with cancer will develop a thromboembolic event. Among solid tumours, ovarian cancer is associated with one of the highest incidence rates of venous thrombosis. We report a case of a 64-year-old woman who presented with asymptomatic increasing Serum CA 125 after 7 years of surgery for ovarian cancer. She underwent whole-body fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT), which showed a large left iliac lesion with extension as ovarian vein tumour thrombus (OVTT) and lung metastases.
Keywords
18F FDG PET/CT
Carcinoma ovary
Ovarian vein tumour thrombosis
Recurrence
A 64 year-old Female diagnosed with high-grade serous carcinoma of the ovary in 2018, underwent neoadjuvant chemotherapy (carboplatin +paclitaxel – 3 cycles), bilateral oophorectomy, omentectomy, and pelvic nodal dissection (R0 resection), and pathology showed yT3bpN1acM0, FIGO stage IIIB. Post-surgery, CA 125 was 3.2ng/ml. She was on follow-up for the last 7 years with no relapse, and recent CA125-141ng/ml showed a rising trend, and she is asymptomatic now. She was referred for whole-body PET/CT for the detection of recurrence. Whole body fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) showed an intensely hypermetabolic enhancing solid cystic lesion in the left iliac fossa encasing iliac vessels and a linear tubular extension of the lesion into the left ovarian vein as tumour thrombosis [Fig 1a-c]. Also, multiple hypermetabolic bilateral pulmonary metastases were noted [Fig 1d].
The Californian cancer registry data reported incidence rates of venous thrombosis in ovarian cancer of 1.6% for the early stage and 6.7% for the advanced stage of disease.[1] One in five patients developed a thrombosis during their cancer-associated lifetime. The peak in incidence is in the immediate months following diagnosis. The median survival in ovarian cancer patients with thrombotic events was 2 years compared with 3 years in their counterparts without thrombosis.[2] Our case of ovarian vein tumour thrombus (OVTT) occurs after 7 years of cancer diagnosis in a recurrence setting. FDG PET/CT is superior to CT and MR imaging for the depiction of recurrent ovarian cancer.[3]
With increasing use of FDG PET/CT in various gynaecological malignancies, incidental observation of tumour thrombosis on PET/CT is not uncommon.[4] Chandra et al described a rare case of right OVTT from a carcinosarcoma uterus recurrence in FDG PET CT. On multi detector computed tomography (MDCT), OVTT appears to be a filling defect within the ovarian vein, which may or may not be enlarged. On coronal reconstruction, this appears like a tubular structure in the retroperitoneum.[5] Our case will be the first case of FDG PET CT showing left OVTT in ovarian cancer recurrence.
Author contributions:
KKK, RE and AS: Contributed in writing and patient care.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for their images and other clinical information to be reported in the journal. The patient understand that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Venous thromboembolism in ovarian cancer. Gynecol Oncol. 2007;105:784-90.
- [CrossRef] [PubMed] [Google Scholar]
- Thrombosis in ovarian cancer: A case control study. Br J Cancer. 2014;110:1118-24.
- [CrossRef] [PubMed] [Google Scholar]
- Role of FDG PET/CT in staging of recurrent ovarian cancer. Radiographics. 2011;31:569-83.
- [CrossRef] [PubMed] [Google Scholar]
- Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging. Rev Esp Med Nucl Imagen Mol. 2015;34:287-94. 10.1016/j.remn.2015.04.002
- [CrossRef] [PubMed] [Google Scholar]
- Rare case of an ovarian vein tumor thrombosis identified on fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med. 2016;31:305-6.
- [CrossRef] [PubMed] [Google Scholar]