Skip to main content
NCBI home page
Molecular Imaging and Radionuclide Therapy logoLink to Molecular Imaging and Radionuclide Therapy
. 2025 Feb 7;34(1):66–69. doi: 10.4274/mirt.galenos.2024.96530

A Rare Case of Synchronous Lobular Breast Carcinoma and Serous Psammocarcinoma of the Ovary Evaluated by 18F-FDG PET/CT

18F-FDG PET/BT ile Değerlendirilen Nadir Bir Senkron Lobüler Meme Karsinomu ve Over Seröz Psammokarsinomu Olgusu

Laure Al Mansour 1, Alexis Trecourt 2, Stela Asadurova 1, Anthime Flaus 1, Matthieu Dietz 1,✉
PMCID: PMC11827521  PMID: 39918077

Abstract

Serous psammocarcinoma of the ovary is a rare variant of ovarian serous carcinoma characterized by the presence of calcified peritoneal lesions, known as psammoma bodies. These calcified lesions may usually be considered benign on computed tomography but may show avidity for 18F-fluorodeoxyglucose (18F-FDG), which can be helpful in the diagnosis of this rare ovarian tumor. We present a rare case of serous psammocarcinoma of the ovary detected during the diagnostic work-up of lobular breast cancer using 18F-FDG positron emission tomography/computed tomography.

Keywords: Psammocarcinoma, ovary, peritoneum, 18F-FDG PET/CT

Ethics

Informed Consent: A written informed consent was obtained.

Figure 1.

Figure 1

Open in a new tab

A 63-year-old woman underwent 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for initial extension work-up of a lobular breast carcinoma. Maximum intensity projection (A), axial attenuation-corrected PET (E), transaxial CT (F), and fused PET/CT (G) images showing intense tracer uptake in the breast lesion (green arrows) associated with homolateral axillary lymph node involvement. Additionally, maximum intensity projection (A), axial attenuation-corrected PET (B), transaxial CT (C), and fused PET/CT (D) images revealed increased 18F-FDG uptake by a large heavily calcified omental soft-tissue mass (red arrows), which was associated with less-FDG-avid disseminated calcified peritoneal lesions. Increased 18F-FDG uptake in the calcified lesion was also observed in non-attenuation corrected images. No ovarian mass was detected.

Figure 2.

Figure 2

Open in a new tab

Histological examination of the peritoneal nodule revealed a desmoplastic stroma containing numerous tumor cell clusters [A, hematoxylin phloxine saffron staining (HES), x10 magnification]. At higher magnification (x180), clusters of tumor cells display micropapillary features and spherical, lamellated, concentric calcified structures corresponding to psammoma bodies (B, HES; blue arrows). Tumor cells were intermediate in size (C, HES; yellow arrow; x240 magnification). Immunohistochemical analysis showed intense and diffuse positivity for PAX8 and WT1, indicative of serous ovarian primary neoplasm (1). The expression of p53 was wild-type (D-F, magnification x200). The final diagnosis of this lesion was low-grade invasive serous carcinoma. The presence of psammoma bodies is characteristic of serous psammocarcinoma of the ovary, a rare variant of ovarian serous carcinoma (2,3,4). Low-grade serous carcinoma has a better prognosis (5,6,7). Calcified peritoneal lesions visualized on CT are explained by the presence of fine calcium particles in psammoma bodies (8,9). These lesions appear to show avidity for 18F-FDG, although only a limited number of cases have been reported on 18F-FDG PET/CT imaging (10,11,12,13). The visualization of a calcified lesion on conventional CT can be falsely reassuring, leading to misdiagnosis (14). This case reinforces the idea that 18F-FDG PET/CT is useful for the diagnosis of this rare type of ovarian tumor.

Footnotes

Authorship Contributions

Concept: L.A.M., M.D., Design: L.A.M., M.D., Data Collection or Processing: L.A.M., A.T., S.A., A.F., M.D., Analysis or Interpretation: L.A.M., A.T., M.D., Literature Search: L.A.M., M.D., Writing: L.A.M., M.D.

Conflict of Interest: No conflicts of interest were declared by the authors.

Financial Disclosure: The authors declare that this study has received no financial support.

References

  • 1.Liliac L, Carcangiu ML, Canevari S, Căruntu ID, Ciobanu Apostol DG, Danciu M, Onofriescu M, Amălinei C. The value of PAX8 and WT1 molecules in ovarian cancer diagnosis. Rom J Morphol Embryol. 2013;54(1):17–27. [PubMed] [Google Scholar]
  • 2.Gilks CB, Bell DA, Scully RE. Serous psammocarcinoma of the ovary and peritoneum. Int J Gynecol Pathol. 1990;9(2):110–121. doi: 10.1097/00004347-199004000-00002. [DOI] [PubMed] [Google Scholar]
  • 3.Alanbay I, Dede M, Ustün Y, Karaşahin E, Deveci S, Günhan O, Yenen MC. Serous psammocarcinoma of the ovary and peritoneum: two case reports and review of the literature. Arch Gynecol Obstet. 2009;279(6):931–936. doi: 10.1007/s00404-008-0826-x. [DOI] [PubMed] [Google Scholar]
  • 4.Jena SK, Mishra P, Mohapatra V, Singh S. Bilateral Serous psammocarcinoma of ovary: rare variant low grade serous carcinoma. Case Rep Obstet Gynecol. 2015;2015:531242. doi: 10.1155/2015/531242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Aure JC, Hoeg K, Kolstad P. Psammoma bodies in serous carcinoma of the ovary. A prognostic study. Am J Obstet Gynecol. 1971;109(1):113–118. doi: 10.1016/0002-9378(71)90844-1. [DOI] [PubMed] [Google Scholar]
  • 6.Kühn W, Kaufmann M, Feichter GE, Schmid H, Hanke J, Rummel HH. Psammomabody content and DNA-flow cytometric results as prognostic factors in advanced ovarian carcinoma. Eur J Gynaecol Oncol. 1988;9(3):234–241. [PubMed] [Google Scholar]
  • 7.Arole VC, Deshpande KA, Jadhav DB, Jogi A. Primary peritoneal psammocarcinoma. J Obstet Gynaecol Res. 2017;43(8):1366–1372. doi: 10.1111/jog.13355. [DOI] [PubMed] [Google Scholar]
  • 8.Mitchell DG, Hill MC, Hill S, Zaloudek C. Serous carcinoma of the ovary: CT identification of metastatic calcified implants. Radiology. 1986;158(3):649–652. doi: 10.1148/radiology.158.3.3945732. [DOI] [PubMed] [Google Scholar]
  • 9.Hiromura T, Tanaka YO, Nishioka T, Tomita K. Serous psammocarcinoma of the ovary: CT and MR findings. J Comput Assist Tomogr. 2007;31:490–492. doi: 10.1097/01.rct.0000243450.48857.3a. [DOI] [PubMed] [Google Scholar]
  • 10.Ozulker T, Ozulker F, Ozpacaci T. 99mTc-MDP and 18F-FDG uptake in calcified metastatic lesions from ovarian papillary serous adenocarcinoma. Hell J Nucl Med. 2009;12(3):287–288. [PubMed] [Google Scholar]
  • 11.Hu SL, Zhou ZR, Zhang YJ. Calcified metastases from ovarian carcinoma highlighted by F-18 FDG PET/CT: report of two cases. Abdom Imaging. 2012;37(4):675–679. doi: 10.1007/s00261-011-9800-3. [DOI] [PubMed] [Google Scholar]
  • 12.Dong A, Wang Y, Zuo C. FDG PET/CT in serous psammocarcinoma of the ovary. Clin Nucl Med. 2014;39(5):453–455. doi: 10.1097/RLU.0b013e318286bdfc. [DOI] [PubMed] [Google Scholar]
  • 13.Inanir S, Oksuzoglu K. FDG PET/CT Imaging of calcified sister mary joseph nodule. Clin Nucl Med. 2016;41:e458–e459. doi: 10.1097/RLU.0000000000001283. [DOI] [PubMed] [Google Scholar]
  • 14.Jeon G, Park SY. Primary peritoneal psammocarcinoma misdiagnosed as an heterotopic ossification: a case report. J Korean Soc Radiol. 2023;84(4):958–963. doi: 10.3348/jksr.2022.0095. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Molecular Imaging and Radionuclide Therapy are provided here courtesy of Galenos Yayinevi

RESOURCES