Opportunities for 2-[(18)F] fluoro-2-deoxy-D-glucose PET/CT in cervical-vaginal neuroendocrine carcinoma: case series and literature review

Abstract

Objective: Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[(18)F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) scan for the detection of this rare malignancy.

Materials and methods: Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5).

Results: Two cases (cases 1 and 4) were restaged after (18)F-FDG PET/CT scan in the initial staging process. Post-treatment (18)F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years.

Conclusion: (18)F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the (18)F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the (18)F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.

Keywords: 18F-FDG PET/CT; Cervical carcinoma; Neuroendocrine carcinoma.

Fig. 1

2-[¹⁸F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography images showed multiple hypermetabolic areas in skeleton (including axial bones and long bones of four limbs), retroperitoneal lymph nodes, liver, lung, uterine cervix, and posterior wall of urinary bladder. Renal cortex, hepatic parenchyma, and soft tissue uptake were faintly visualized. PET = positron emission tomography

Fig. 2

2-[¹⁸F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography images showed lesion in uterine cervix and no distal metastases. PET = positron emission tomography

Fig. 3

2-[¹⁸F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) images after radical hysterectomy showed multiple ¹⁸F-FDG-avid lesions in mediastinum, liver and left kidney, which were consistent with metastases.

Fig. 4

2-[¹⁸F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) images showed huge ¹⁸F-FDG-avid mass in posterior pelvis, which was compatible with cervical cancer. Several hypermetabolic lesions in bilateral iliac and retroperitoneal regions were demonstrated, which were mostly related to metastatic lymph nodes. Incidentally, hypermetabolic lesion in left breast was also noted. Biopsy of this lesion showed metastatic neuroendocrine carcinoma.

Fig. 5

2-[¹⁸F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography images showed lesion in vagina. PET = positron emission tomography

Fig. 6

This is 28-year-old woman. Histopathological examination (× 100) of tumor showed infiltration of blue round cells with vesicular nuclei, scanty cytoplasma, high nuclear/cytoplasma ratio and extensive necrosis arranged in nest on hematoxylin and eosin stain (A); and positive immunohistochemical stain for synaptophysin (B). These features confirmed diagnosis of neuroendocrine carcinoma.