INTERESTING IMAGE
Paraganglioma and Pancreatic Neuroendocrine Tumor With Rare Metastatic Sites Detected on 68Ga-DOTATATE PET/CT Imaging Rahul Vithalrao Parghane, MD,* Bhagwant Rai Mittal, MD, DNB,* Jaya Shukla, PhD, MSc,* Pranab Dey, MD,† Anish Bhattacharya, DNB,* and Rakesh Kochhar, MD, DM‡ Abstract: Pancreatic neuroendocrine tumors (PNETs) represent a small percentage of all pancreatic malignancies, and most of these present as metastatic disease. Somatostatin receptor scintigraphy had been used successfully for the assessment of patients with NET. Somatostatin receptor scintigraphy is indispensable for localization of ectopic NET and the distribution of NET throughout the body. Key Words: 68Ga-DOTATATE, fine-needle aspiration cytology, PET-CT, somatostatin receptor, PNET (Clin Nucl Med 2015;40: 256–257)
Received for publication April 5, 2014; revision accepted September 23, 2014. From the *Department of Nuclear Medicine & PET, †Cytology and Gynaecological Pathology, and ‡Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Conflicts of interest and sources of funding: none declared. Reprints: Bhagwant Rai Mittal, MD, DNB, Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India. E-mail: [email protected]. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4003–0256
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REFERENCES 1. Plöckinger U, Rindi G, Arnold R, et al. Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumors. A consensus statement on behalf of the European Neuroendocrine Tumor Society (ENETS). Neuroendocrinology. 2004;80:394–424. 2. Tomassetti P, Campana D, Piscitelli L, et al. Endocrine tumors of the ileum: factors correlated with survival. Neuroendocrinology. 2006;83:380–386. 3. Unger P, Schwartz AE, Pertsemlidis D, et al. Endocrine surgery. In: Pathology of Pancreatic Endocrine Neoplasia. New York: Marcel Dekker Inc; 2004:500–520. 4. Solorzano CC, Lee JE, Pisters PW, et al. Nonfunctioning islet cell carcinoma of the pancreas: survival results in a contemporary series of 163 patients. Surgery. 2001;130:1078–1085. 5. Satahoo-Dawes S, Palmer J, Manning EW III, et al. Breast and lung metastasis from pancreatic neuroendocrine carcinoma. World J Radiol. 2011;3:32–37. 6. Bruzoni M, Parikh P, Celis R, et al. Management of the primary tumor in patients with metastatic pancreatic neuroendocrine tumor: a contemporary singleinstitution review. Am J Surg. 2009;197:376–381. 7. Clancy TE, Sengupta TP, Paulus J, et al. Alkaline phosphatase predicts survival in patients with metastatic neuroendocrine tumors. Dig Dis Sci. 2006;51:877–884. 8. van der Harst HE, de Herder WW, Bruining HA, et al. (123)I metaiodobenzylguanidine and (111)In octreotide uptake in benign and malignant pheochromocytomas. J Clin Endocrinol Metab. 2001;86:685–693. 9. Mundschenk J, Unger N, Schulz S, et al. Somatostatin receptor subtypes in human pheochromocytoma: subcellular expression pattern and functional relevance for octreotide scintigraphy. J Clin Endocrinol Metab. 2003;88:5150–5157. 10. Bodei L, Pepe G, Paganelli G. Peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors with somatostatin analogues. Eur Rev Med Pharmacol Sci. 2010;14:247–255.
Clinical Nuclear Medicine • Volume 40, Number 3, March 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 3, March 2015
Detection of Rare Metastatic Sites and Paraganglioma
FIGURE 1. A 32-year-old female patient presented with abdominal pain and swelling in the neck for 7 months. Contrast-enhanced computed tomography showed multiple pancreatic space-occupying lesions, and endoscopic ultrasound shows lobulated pancreas with heteroechoic echo texture in the head and tail of the pancreas. Chromogranin A level was raised to 298 ng/mL (reference,
Paraganglioma and Pancreatic Neuroendocrine Tumor With Rare Metastatic Sites Detected on 68Ga-DOTATATE PET/CT Imaging Rahul Vithalrao Parghane, MD,* Bhagwant Rai Mittal, MD, DNB,* Jaya Shukla, PhD, MSc,* Pranab Dey, MD,† Anish Bhattacharya, DNB,* and Rakesh Kochhar, MD, DM‡ Abstract: Pancreatic neuroendocrine tumors (PNETs) represent a small percentage of all pancreatic malignancies, and most of these present as metastatic disease. Somatostatin receptor scintigraphy had been used successfully for the assessment of patients with NET. Somatostatin receptor scintigraphy is indispensable for localization of ectopic NET and the distribution of NET throughout the body. Key Words: 68Ga-DOTATATE, fine-needle aspiration cytology, PET-CT, somatostatin receptor, PNET (Clin Nucl Med 2015;40: 256–257)
Received for publication April 5, 2014; revision accepted September 23, 2014. From the *Department of Nuclear Medicine & PET, †Cytology and Gynaecological Pathology, and ‡Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Conflicts of interest and sources of funding: none declared. Reprints: Bhagwant Rai Mittal, MD, DNB, Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012 India. E-mail: [email protected]. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4003–0256
256
www.nuclearmed.com
REFERENCES 1. Plöckinger U, Rindi G, Arnold R, et al. Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumors. A consensus statement on behalf of the European Neuroendocrine Tumor Society (ENETS). Neuroendocrinology. 2004;80:394–424. 2. Tomassetti P, Campana D, Piscitelli L, et al. Endocrine tumors of the ileum: factors correlated with survival. Neuroendocrinology. 2006;83:380–386. 3. Unger P, Schwartz AE, Pertsemlidis D, et al. Endocrine surgery. In: Pathology of Pancreatic Endocrine Neoplasia. New York: Marcel Dekker Inc; 2004:500–520. 4. Solorzano CC, Lee JE, Pisters PW, et al. Nonfunctioning islet cell carcinoma of the pancreas: survival results in a contemporary series of 163 patients. Surgery. 2001;130:1078–1085. 5. Satahoo-Dawes S, Palmer J, Manning EW III, et al. Breast and lung metastasis from pancreatic neuroendocrine carcinoma. World J Radiol. 2011;3:32–37. 6. Bruzoni M, Parikh P, Celis R, et al. Management of the primary tumor in patients with metastatic pancreatic neuroendocrine tumor: a contemporary singleinstitution review. Am J Surg. 2009;197:376–381. 7. Clancy TE, Sengupta TP, Paulus J, et al. Alkaline phosphatase predicts survival in patients with metastatic neuroendocrine tumors. Dig Dis Sci. 2006;51:877–884. 8. van der Harst HE, de Herder WW, Bruining HA, et al. (123)I metaiodobenzylguanidine and (111)In octreotide uptake in benign and malignant pheochromocytomas. J Clin Endocrinol Metab. 2001;86:685–693. 9. Mundschenk J, Unger N, Schulz S, et al. Somatostatin receptor subtypes in human pheochromocytoma: subcellular expression pattern and functional relevance for octreotide scintigraphy. J Clin Endocrinol Metab. 2003;88:5150–5157. 10. Bodei L, Pepe G, Paganelli G. Peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors with somatostatin analogues. Eur Rev Med Pharmacol Sci. 2010;14:247–255.
Clinical Nuclear Medicine • Volume 40, Number 3, March 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 3, March 2015
Detection of Rare Metastatic Sites and Paraganglioma
FIGURE 1. A 32-year-old female patient presented with abdominal pain and swelling in the neck for 7 months. Contrast-enhanced computed tomography showed multiple pancreatic space-occupying lesions, and endoscopic ultrasound shows lobulated pancreas with heteroechoic echo texture in the head and tail of the pancreas. Chromogranin A level was raised to 298 ng/mL (reference,
