Bilateral Ovarian Metastases of Hepatocellular Carcinoma Diagnosed with F-Fluorocholine PET/CT in a Patient with Endometriosis.

A 47-year-old woman with history of hepatocellular carcinoma was referred for F-fluorocholine PET/CT evaluation due to elevated alpha-fetoprotein. The examination showed several peritoneal uptakes and two nodular pelvic foci. Coelioscopic exploration allowed confirmation and resection of multiple peritoneal metastases from hepatocellular carcinoma while pelvic biopsies revealed endometriosis and endosalpingiosis. However, alpha-fetoprotein kept rising: subsequent F-fluorodesoxyglucose PET/CT exploration found no pelvic uptake, while F-fluorocholine PET/CT revealed intense tracer accumulation in the two pelvic masses corresponding to bilateral ovarian metastases of hepatocellular carcinoma. We highlight the importance of F-fluorocholine PET/CT in hepatocellular carcinoma especially in patients with confounding comorbidities such as endometriosis.