PMC8214344_01
ACTH induced hyperpigmentation.
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However, she continued to have increasing hyperpigmentation (Figure 1) and CTTAP imaging surveillance 6 months after her surgery showed increase in size of her uterine lesion likely right adnexal in origin measuring 5.8x5.2x5.2 cm in size (Figure 2A).
(A) CT image showing heterogenous multilobulated pelvic lesion; (B) Ga-68 DOTANOC PET-CT showing pelvic lesion with no SSTR avid disease. (C) FDG PET-CT showing FDG hypermetabolism of the pelvic lesion.
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However, she continued to have increasing hyperpigmentation (Figure 1) and CTTAP imaging surveillance 6 months after her surgery showed increase in size of her uterine lesion likely right adnexal in origin measuring 5.8x5.2x5.2 cm in size (Figure 2A). F18-FDG PET/CT imaging were performed showing predominantly FDG avid disease (Figure 2B and 2C), hence she was deemed unsuitable for peptide receptor radionuclide therapy (PRRT). Following multidisciplinary team discussion, she was recommended for surgery to remove the adnexal lesion.
(A) Large right ovarian tumour, 2 left ovarian cysts and omentum; (B) Ruptured right pelvic tumour, uterus with left ovarian tumour.
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Intra-operative findings showed a right large ovarian tumour measuring 10x10 cm adherent to the right pelvic wall and 2 cysts in the left ovary measuring 1x1 cm and 2x2 cm (Figure 3A). Intra-operative findings showed a 6-week size uterus, a 3x3 cm left ovarian tumour with intact capsule and a ruptured right sided pelvic wall tumour measuring 5x4 cm (Figure 3B).
ACTH trend since diagnosis and corresponding normal range. Difference in ACTH cut-offs before and after 22 months was due to a change in assay used.
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Marked improvement in ACTH levels were noted after surgery (Figure 4). However, CTTAP at 6 months showed progression of her left adnexal mass and ACTH levels continued to increase (Figure 4). After surgery, her ACTH levels reduced to 49.5pmol/L and the trend is demonstrated in Figure 4.