ABSTRACT
Neuroendocrine tumors (NET) are a heterogeneous group of neoplasms that originate in tissues derived from the neural crest, whose characteristic feature is the expression of neuroendocrine markers and somatostatin receptors. Here, we present the case of a patient with a surgically intervened small bowel NET. Focal uptake was identified in the unresected mesentery in the scintigraphy of somatostatin receptors (99mTc-Tektrotyd). A second intervention was performed with intraoperative radio-guided detection with a gamma probe and a handheld SPECT. An intraoperative radioguided technique allowed the detection of a lesion that was confirmed by histology to be a lymph node metastasis of the NET and a nodule of NET in the anastomosis of the first surgical intervention.
Subject(s)
Breast Neoplasms , Neuroendocrine Tumors , Pancreatic Neoplasms , Female , Humans , Lymphatic Metastasis , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/surgery , Pancreatic Neoplasms/diagnostic imaging , Radionuclide Imaging , RadiopharmaceuticalsABSTRACT
Los tumores neuroendocrinos (TNE) son un grupo heterogéneo de neoplasias que tienen origen en tejidos derivados de la cresta neural, que expresan marcadores neuroendocrinos y receptores de somatostatina. Presentamos el caso de una paciente con un TNE de intestino delgado previamente intervenido. En la gammagrafía de receptores de somatostatina (GRS/99mTc-Tektrotyd) se identificó un foco en mesenterio no resecado. Se realizó una segunda intervención con detección radioguiada con sonda gamma y con SPECT-portátil. Permitió detectar una lesión que se confirmó por histología como metástasis ganglionar de TNE y un nódulo de TNE en la anastomosis de la primera intervención quirúrgica
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Subject(s)
Humans , Male , Middle Aged , Neuroendocrine Tumors/diagnostic imaging , Radionuclide Imaging , Surgery, Computer-Assisted/methods , Neoplasm Metastasis/diagnostic imaging , Intestine, Small/diagnostic imaging , Intestine, Small/pathology , Laparotomy/methods , Tomography, Emission-Computed, Single-Photon , Receptors, Somatostatin/radiation effects , Neoplasm Metastasis/pathology , Anastomosis, Surgical/methodsABSTRACT
PURPOSE: Stimulated thyroglobulin (Tg) and (131)I total-body scan (TBS) have been the mainstays of differentiated thyroid carcinoma (DTC), but now diagnostic TBS has been eliminated from some follow-up protocols. Nevertheless, Tg can be negative in the presence of thyroid tissue, and moderately elevated Tg poses management problems. The purpose of this study was to check how many patients have Tg negative but visible thyroid tissue and if diagnostic TBS could be clinically useful. MATERIAL AND METHODS: Retrospective review of 317 exams (stimulated Tg and TBS) of 128 patients with DTC. Patients with high-grade criteria and/or positive autoantibodies are excluded. Tg is considered positive if higher than the sensitivity level of the technique. TBS is positive if thyroid remnant, lymphatic node or metastases are detected. Results are classified in Tg and TBS concordant or discordant. RESULTS: Discordant (131)I TBS and Tg were found in 74/317 studies (23.3%), 48 (65%) being TBS positive and Tg negative. None of 128 patients had a first post-surgery negative scan, but 13 (10%) were Tg negative, even two patients with lymph node uptake. One year after radioiodine treatment, 26 out of 115 patients (initially Tg and TBS concordant positive) showed Tg negative and TBS still positive due to cervical remnants (20 patients), lymph node uptake (one) and metastasis (five); 20 patients remained Tg and TBS positive, but 14 of them only showed thyroid remnants. CONCLUSIONS: We propose to perform periodic diagnostic TBS to improve Tg specificity, at least while neck thyroid activity is detected, even if Tg is negative.
