PMC9643837_01
Images of 18F-FDG PET/CT. (A) No obvious abnormality is found in the maximum intensity projection (MIP) image. (B-D) The axial images of the abdominal cavity reveal slight FDG activity in the thickened gastric wall (long arrows; SUVmax 3.8). (E-G) Similarly, the axial images of the pelvic cavity show an abnormal mass with a slight FDG uptake in the right adnexal area (short arrows; SUVmax 3.0).
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Fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT ( Figure 1 ) results revealed slight FDG activity in the thickened gastric wall (SUVmax 3.8) and an abnormal mass in the right adnexal area (SUVmax 3.0).
Images of 68Ga-FAPI PET/CT. (A) The MIP image shows several lesions with varying degrees of FAPI uptake. (B-D) Axial views of abdominal cavity demonstrate significantly elevated FAPI activity in the thickened gastric wall (long arrows; SUVmax 9.8). (E-G) The axial images of pelvic cavity reveal abnormal FAPI uptake in the bilateral adnexal areas (short arrows; SUVmax of right 11.6, SUVmax of left 6.5). (C, D) Furthermore, 68Ga-FAPI PET/CT showed extensive peritoneal carcinomatosis with FAPI uptake (dotted arrows; SUVmax 3.9).
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Figure 2 ) results demonstrated significantly elevated FAPI activity in the thickened gastric wall (SUVmax 9.8) and a mass in the right adnexal area (SUVmax 11.6). Furthermore, 68Ga-FAPI PET/CT showed extensive peritoneal carcinomatosis with FAPI uptake (SUVmax 3.9) and a mass in the left adnexal area with moderate FAPI activity (SUVmax 6.5).
Biopsy results of (A) gastric wall, (B) pelvic nodule, (C) right ovary, and (D) left ovary confirm that there are gastric, peritoneal, and ovarian metastases from breast cancer.
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In addition to gastric metastasis, histopathological and immunohistochemical examinations of bilateral adnexectomy and peritoneal nodule confirmed that both the peritoneum and bilateral ovaries had metastases from breast cancer ( Figure 3 ).