Iranian Journal of Nuclear Medicine

Iranian Journal of Nuclear Medicine

[18F]FDG PET/CT in jejunal mucin-producing adenocarcinoma with bilateral ovarian metastases

Articles in Press

Document Type : Case Report

Authors
Raheleh Hedayati 1
Leila Hassanzadeh 1
Mohammad Javad Yasemi 1, 2
Marzieh Ebrahimi 1, 3
1 Department of Nuclear Medicine, Hazrat-e Rasoul Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Firoozabadi Clinical Research Development Unit, Department of Nuclear Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
10.22034/irjnm.2026.130653.1783
Abstract
Small bowel adenocarcinoma is an uncommon gastrointestinal malignancy, and ovarian metastasis from a jejunal primary is rare. We report the [18F]FDG PET/CT findings of a 39-year-old woman with a previously diagnosed moderately differentiated mucin-producing adenocarcinoma arising in a tubulovillous adenoma of the jejunum with visceral peritoneal invasion. The patient had undergone surgery and systemic chemotherapy and was referred for restaging because of bilateral ovarian masses suspicious for Krukenberg tumors. Whole-body [18F]FDG PET/CT demonstrated large bilateral ovarian masses with metabolically active solid components, showing markedly higher FDG uptake in the right ovarian lesion than in the left. A small FDG-avid retroperitoneal focus adjacent to the abdominal aorta at the L4 level was also detected and was suspicious for metastatic involvement. No definite focal FDG uptake was identified at the bowel loops to suggest intraluminal recurrence, and a previously described omental/peritoneal implant showed no definite abnormal [18F]FDG uptake, highlighting a potential limitation of [18F]FDG PET/CT in mucinous peritoneal disease. Histopathologic examination of the ovarian masses confirmed metastatic adenocarcinoma consistent with the known jejunal primary. Based on the imaging, histopathologic findings and overall metastatic disease burden, the patient was referred for second-line chemotherapy and palliative management. This case illustrates the value of [18F]FDG PET/CT in restaging metastatic jejunal adenocarcinoma and detecting metabolically active ovarian and retroperitoneal metastatic disease, while emphasizing the need for careful interpretation of non-FDG-avid mucinous peritoneal deposits.
Keywords
Jejunal adenocarcinoma
Small bowel adenocarcinoma
[18F]FDG PET/CT
Ovarian metastases
Krukenberg tumor
Mucin-producing adenocarcinoma
Subjects
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Iranian Journal of Nuclear Medicine

Articles in Press, Accepted Manuscript
Available Online from 02 November 2026