Novel application of Yttrium-90 microsphere selective internal radiation therapy in hepatic metastases of primary fallopian tube carcinoma

A 67-year-old postmenopausal woman presented with a 1-month history of abdominal pain. Abdominal ultrasound revealed multiple mixed hypoechoic hepatic masses, the largest measuring 8.5 cm × 5.5 cm. Serum levels of CA125, HE4, and CA724 were markedly elevated. Partial hepatectomy biopsy demonstrated adenocarcinoma with immunohistochemical positivity for PAX-8, CK, and CK7. Positron emission tomography/computed tomography (PET/CT) showed multifocal hypermetabolic hepatic lesions consistent with metastases, with a possible origin from the left adnexa. Gynecological ultrasound confirmed a tubular mass in the left adnexal region. The patient subsequently underwent bilateral salpingo-oophorectomy. Histopathology of the left adnexal mass showed cystic-solid tumor involving vascular walls and adjacent smooth muscle (Figure 1A). The neoplasm formed glands, papillae, and solid sheets within luminal and mural compartments. Immunohistochemistry demonstrated positivity for PAX-8, PAX-2, p16, and ER, and negativity for p53, Napsin A, CD10, and Calretinin (Figure 1B). Genetic testing showed BRCA1/2 wild-type and TP53 mutation. The findings established a diagnosis of high-grade serous carcinoma of fallopian tube origin. Following two cycles of TC regimen (liposomal paclitaxel/carboplatin), abdominal CT confirmed hepatic metastasis progression. Trans-arterial chemoembolization was carried out, followed by four cycles of IAP regimen (ifosfamide, doxorubicin, cisplatin) maintenance therapy, yet hepatic lesions continued to enlarge. This patient was referred to our hospital for advanced treatment. Abdominal CT revealed multiple mixed hypodense masses in the liver (Figure 1C). The patient’s baseline evaluation was as follows: Eastern Cooperative Oncology Group performance status score of 2, Child-Pugh score of 7 (class B), and indocyanine green retention test at 15 min of 12.8%. After multidisciplinary team consultation, selective internal radiation therapy (SIRT) with Yttrium-90 was planned. On March 24, 2025, mapping angiography and cone beam CT confirmed that the tumour was predominantly supplied by right, left and middle hepatic arteries (Figure 1D-1F). The cystic artery was embolized with 2–3 mm coils to prevent non-target deposition. The microcatheter was positioned sequentially into the right, left and middle hepatic arteries, and 99mTc-macroaggregated albumin was infused as a mapping agent (5.0, 2.5 and 2.5 mCi, respectively). Single-photon emission computed tomography/CT (SPECT/CT) showed no extrahepatic uptake and the calculated lung shunt fraction was 6.7% (Figure 1G). Two weeks later, SIRT was carried out. Yttrium-90 resin microspheres were infused into the left hepatic artery (0.4 GBq), the middle hepatic artery (0.5 GBq), and the right hepatic artery (1.8 GBq). Post-procedure SPECT/CT confirmed uniform microsphere deposition and full delivery of the intended therapeutic dose (Figure 1H). The post-procedure PET/CT results were consistent with the SPECT/CT findings (Figure 1I). The patient remained free of adverse events and was discharged the following day. The liver metastases reduced after a 3-month follow-up (Figure 2). The patient is still under follow-up.

Figure 1 The pathology and imaging of this patient. (A) The histopathological examination of the left adnexal mass revealed a tumor involving the vascular walls and adjacent smooth muscle tissue (H&E, 400× magnification). (B) The immunohistochemical analysis demonstrated positive staining for PAX-8 (400× magnification). (C) The abdominal CT scan showed several mixed hypodense masses in the liver. (D-F) The CBCT exhibited that the right hepatic artery, middle hepatic artery, and left hepatic artery supply the metastatic tumors, respectively. (G) The SPECT/CT scan revealed that the calculated lung shunt fraction was 6.7%. (H) The post-procedure SPECT/CT scan demonstrated consistent microsphere distribution. (I) The post-procedure PET/CT results were in agreement with the SPECT/CT findings. CBCT, cone beam CT; CT, computed tomography; H&E, hematoxylin and eosin; PET, positron emission tomography; SPECT, single-photon emission computed tomography.

Figure 2 Magnetic resonance imaging of the liver before treatment and at the 3-month follow-up. (A) The pre-treatment T2-weighted image showed multiple hyperintense nodules and masses, some presenting as confluent lesions. (B) The follow-up image revealed partial shrinkage of some lesions.

Primary fallopian tube carcinoma is a rare gynecologic malignancy that predominantly affects menopausal women (1). The National Comprehensive Cancer Network (NCCN) guidelines recommend Yttrium-90 radioembolization for patients with advanced hepatocellular carcinoma and colorectal liver metastases that are refractory to chemotherapy. Recently, this treatment has also been utilized for other hepatic metastases, such as thymic malignancies, solitary fibrous tumors, and insulinoma (2-4). We report the first application of SIRT with Yttrium-90 for hepatic metastases originating from fallopian tube carcinoma, which may serve as an effective alternative for patients ineligible for surgical resection. Future research needs to evaluate the long-term efficacy and adverse reactions of this method.

This study was conducted in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from the patient for publication of this article.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article has undergone external peer review.

Peer Review File: Available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-2025-569/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-2025-569/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from the patient for publication of this article.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the Fallopian tube. Int J Gynaecol Obstet 2003;83:119-33. [Crossref] [PubMed]
2. Yuan G, Petre EN, Ziv E, et al. Yttrium-90 Radioembolization for Hepatic Metastases Secondary to Thymic Malignancies: A Case Report. JTO Clin Res Rep 2025;6:100812. [Crossref] [PubMed]
3. Badran O, Dereza S, Mireb L, et al. Case Report: Successful Treatment of Solitary Fibrous Tumor with Selective Internal Radiation Therapy (SIRT). Diseases 2024;12:290. [Crossref] [PubMed]
4. Şahin R, Rakıcı İT, Baloğlu MC, et al. 68Ga-NODAGA-Exendin-4 PET/CT Findings in a Case of Metastatic Insulinoma With Refractory Hypoglycemia Controlled by 90Y Transarterial Radioembolization. Clin Nucl Med 2024;49:e392-3. [Crossref] [PubMed]