(18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging of extra-medullary plasmacytoma of the ovary.

Extrameduallary plasmacytoma of ovary is extremely rare. We report a case of involvement of ovary in a treated case of plasmacytoma of 2(nd) part of duodenum, which was initially thought to be physiological luteal activity. However, follow up whole body FDG PET-CT scan shows appearance of metabolically active soft tissue mass in left adnexal region which confirmed to be extra-medullary plasmacytoma of ovary on histopathology.

We report 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) of plasmacytoma of the ovary. A 38-year-old female with plasmacytoma of the second portion of the duodenum/pancreatic head, status post Whipple's procedure and radiation therapy, was found to have a hypermetabolic mass in the left ovary on a follow-up FDG PET/CT scan [Figures 1–3]. Subsequently, patient underwent hysterectomy and left salpingo-oophorectomy with pathology demonstrating plasmacytoma with anaplastic features. Extramedullary plasmacytoma represent 3% of all plasma cell neoplasms and involvement of the ovary is extremely rare.[12] While plasmacytoma of the ovary is rare (eight reported cases),[123] knowledge of this presentation is important for accurate diagnosis. FDG PET scan is a useful tool in diagnosing and managing extramedullary plasmacytomas as reported previously.[1234567] This interesting case also illustrates the utility of FDG PET/CT in the evaluation of extramedullary plasmacytomas.

Figure 1

Patient presented initially in August 2011 with symptoms suggestive of gastric outlet obstruction. A biopsy revealed a solitary plasmacytoma in the duodenum, which was 5.4 cm in size. A staging positron emission tomography/computed tomography scan (a-d) revealed a mass in the duodenum with maximum standard uptake value by body weight (standardized uptake value max) of 11.4. In addition, there is ureteric activity in the pelvis and there was brown fat activity in the supraclavicular, cervical, paravertebral, axillary and mediastinal regions

Figure 3

Fluorodeoxyglucose positron emission tomography/computed tomography scan (a-b) demonstrated no abnormal activity in left adnexal region one year after hysterectomy and left salpingoophorectomy

One month following radiation therapy of the duodenal plasmacytoma, maximum intensity projection image (a) of positron emission tomography/computed tomography demonstrated a hypermetabolic soft-tissue density in the left ovary, with standardized uptake value max of 9.4 that was attributed to corpus luteal activity. Five months following the initial diagnosis, a Whipple's procedure was performed. Subsequently a restaging PET/CT (b-f) showed FDG avid soft tissue mass in left adnexa with a SUV max of 8.7, raising suspicion for malignancy