Use of F 18-fluoro-D-glucose–positron emission tomography–computed tomography to localize a hilar cell tumor of the ovary

Objective To describe provocative testing and alternative imaging strategies used to localize an androgen-producing tumor in a 58-year-old woman with severe hirsutism. Design Case report. Setting Clinical Research Center. Patient(s) A 58-year-old woman who was seen for evaluation of severe hirsutism. Intervention(s) Serum androgen levels were measured at baseline, 4 hours after administration of 2000 IU of hCG, and 11 days after administration of 3.75 mg of leuprolide acetate (LA). Magnetic resonance imaging and F 18-fluoro-D-glucose–positron emission tomography–computed tomography (FDG-PET/CT) were performed. Main Outcome Measure(s) Description of preoperative provocative testing and imaging. Result(s) In response to hCG, T rose from 243 to 288 ng/dL then decreased to 233 ng/dL after LA administration. The FDG-PET/CT scan demonstrated focal hypermetabolism in the right pelvis, corresponding to a soft-tissue density on the noncontrast CT scan. Magnetic resonance images were correlated with the PET/CT, and the right ovary was identified. Right salpingo-oophorectomy was performed, and final pathologic examination revealed a hilar cell tumor with ovarian cortical hyperplasia. Conclusion(s) This case demonstrates the utility of provocative testing in the evaluation of a patient with severe hirsutism and illustrates the value of FDG-PET/CT when traditional imaging is nondiagnostic.