PMC3862223_01
A. The ovarian tumor, showing typical clear cell carcinoma, composed of an admixture of clear cells and cells with eosinophilic cytoplasm, with malignant cytological features. B. Bone biopsy, showing metastatic clear cell carcinoma, morphologically identical to that seen in the ovary.
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Laparotomy revealed high grade clear cell carcinoma of the right ovary (OCCC) only, without surface involvement but with positive ascitic fluid and no extra-ovarian spread, FIGO stage IC (Fig. 1A). A core biopsy of the left proximal femur subsequently confirmed the presence of metastatic ovarian carcinoma of OCCC histology (Fig. 1B).
A. Initial whole body bone scan demonstrating a single abnormality of the let proximal femur. B. Initial PET scan demonstrating cancer involvement of the left femur. C. PET scan post radiation demonstrating response.
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A bone scan revealed a solitary focus of increased uptake in the intertrochanteric region of the proximal left femur (Fig. 2A), with metastasis suspected. This metastasis was also visualized on 18F-FDG PET/CT (Fig. 2B), which also revealed regions of increased activity in the left sacrum and right ilium. The previously irradiated area of the left femur however had "interval metabolic response to treatment with only minimal residual FDG accumulation persisting" (Fig. 2C).