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Rare case of gall bladder neuroendocrine tumor: 18F-FDG and 68Ga-DOTANOC PET/CT findings
Caso poco frecuente de tumor neuroendocrino en la vesícula biliar: hallazgos de la PET/CT con 18F-FDG y 68Ga-DOTANOC
P.S. Chakraborty, V.S. Dhull, S. Karunanithi, S.G. Roy, R. Kumar
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Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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(A) Right breast palpable induration – arrow head, measuring 6.9<span class="elsevierStyleHsp" style=""></span>mm – double headed arrow. (B) Left axillary adenopathy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Argibay, S.M. Nieves, M. Garrido, V. Pubul, P. Rial, L. Sanmartin" "autores" => array:6 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Argibay" ] 1 => array:2 [ "nombre" => "S.M." "apellidos" => "Nieves" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Garrido" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Pubul" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Rial" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Sanmartin" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914001001?idApp=UINPBA00004N" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914001001/v1_201408200020/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253808914000974" "issn" => "22538089" "doi" => "10.1016/j.remnie.2014.06.011" "estado" => "S300" "fechaPublicacion" => "2014-09-01" "aid" => "558" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2014;33:314-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 268 "formatos" => array:2 [ "HTML" => 156 "PDF" => 112 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Post-traumatic psoas abscess diagnosed by <span class="elsevierStyleSup">18</span>F FDG PET/CT" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "314" "paginaFinal" => "315" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Abceso post-traumático del psoas diagnosticado por <span class="elsevierStyleSup">18</span>F-FDG PET/TC" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2589 "Ancho" => 2112 "Tamanyo" => 430408 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">PET images showed increased FDG uptake on along the left psoas muscle that include ametabolic areas (arrows at maximum intensity projection (A), coronal and axial fusion images (B and D)). CT images also revealed asymmetric muscle thickening accompanied by hypodense areas and air density (arrows at coronal and axial CT images (C and E)). On the PET/CT images, ametabolic sclerotic foci in T3 (F and G, thin arrows) and L1 vertebrae were seen; while in the MRI, performed for the verification of the abscess that was suspected in the PET/CT, degenerative changes in L1 and L2 vertebrates and right hip were detected. Also an increased focal FDG uptake in an incidental nodular lesion in superficial lobe of left parotid gland and a mild FDG uptake on the upper lobe of left lung due to radiotherapy (F and G, thick arrows) were seen in PET/CT. In addition, physiological vocal cord and mouth activity was seen in neck region. Any FDG uptake indicating metastasis was not detected.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Reyhan" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Reyhan" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914000974?idApp=UINPBA00004N" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914000974/v1_201408200020/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Rare case of gall bladder neuroendocrine tumor: <span class="elsevierStyleSup">18</span>F-FDG and <span class="elsevierStyleSup">68</span>Ga-DOTANOC PET/CT findings" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "316" "paginaFinal" => "317" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P.S. Chakraborty, V.S. Dhull, S. Karunanithi, S.G. Roy, R. Kumar" "autores" => array:5 [ 0 => array:2 [ "nombre" => "P.S." "apellidos" => "Chakraborty" ] 1 => array:2 [ "nombre" => "V.S." "apellidos" => "Dhull" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Karunanithi" ] 3 => array:2 [ "nombre" => "S.G." "apellidos" => "Roy" ] 4 => array:4 [ "nombre" => "R." "apellidos" => "Kumar" "email" => array:1 [ 0 => "rkphulia@yahoo.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Caso poco frecuente de tumor neuroendocrino en la vesícula biliar: hallazgos de la PET/CT con <span class="elsevierStyleSup">18</span>F-FDG y <span class="elsevierStyleSup">68</span>Ga-DOTANOC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2022 "Ancho" => 4514 "Tamanyo" => 645573 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">68</span>Ga-DOTANOC maximum intensity projection (MIP), CT and PET/CT images showing well-defined large gall bladder mass infiltrating into adjacent liver parenchyma with area of central necrosis and marginal uptake (SUVmax-20.5) of the radiotracer (A–C, arrow). <span class="elsevierStyleSup">18</span>F-FDG MIP, CT and PET/CT images of the same patient revealed intense FDG uptake (SUVmax-27.9) in the same gall bladder mass (D–F, arrow). Symmetric foci of uptake in neck and thorax were due to FDG uptake in brown fat tissue (D, dotted arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 33-year-old female patient who presented 1 year back with anorexia, bloating after meals and cachexia for duration of 4 months. She underwent a contrast enhanced computed tomography (CECT) of the abdomen which revealed an irregular large, lobulated, space occupying lesion involving gall bladder (GB) and adjacent segment 5 of liver. Gross ascites, periportal and peripancreatic lymphadenopathy were also noted. CT guided biopsy from GB mass was suggestive of high grade neuroendocrine tumor (NET). Ki-67 index was >20. Her serum Chromogranin A (CgA) levels were 632.64<span class="elsevierStyleHsp" style=""></span>U/ml. As a part of metastatic work up, the patient was referred to our department for <span class="elsevierStyleSup">68</span>Ga-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-Octreotide (<span class="elsevierStyleSup">68</span>Ga-DOTANOC) positron emission tomography-computed tomography (PET/CT) to look for disease status. <span class="elsevierStyleSup">68</span>Ga-DOTANOC PET/CT revealed ill-defined large gall bladder mass (measuring 55<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>43<span class="elsevierStyleHsp" style=""></span>mm) with loss of fat plane and infiltration into adjacent liver parenchyma (segment 5) showing central necrosis and increased DOTANOC uptake (SUVmax-20.5) at the margins (A–C, arrow). No other abnormal radiotracer uptake was noted elsewhere. In view of high grade NET, the patient underwent <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose (<span class="elsevierStyleSup">18</span>F-FDG) PET/CT for further evaluation of disease status. <span class="elsevierStyleSup">18</span>F-FDG PET/CT revealed a large ill-defined soft tissue density mass in gall bladder fossa with central necrosis with infiltration of adjacent liver parenchyma and peripherally increased <span class="elsevierStyleSup">18</span>F-FDG uptake (SUVmax-27.9) (D–F, arrow). In view of high grade NET, patient received chemotherapy and was doing well at 1 year of follow-up.</p><p id="par0010" class="elsevierStylePara elsevierViewall">NETs originate from neural crest cells and are usually found in the gastrointestinal tract, pancreas, lungs and rarely in some atypical sites like thymus or ovary. Primary GB NET accounts for only 2% cases of all the GB carcinomas and about 0.5% cases of all the NETs arising anywhere in the body.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> NETs usually express somatostatin receptors (SSTR). High grade NETs show more avidity for <span class="elsevierStyleSup">18</span>F-FDG than SSTR binding radiotracers. The cause may be explained by the fact that somatostatin binding to SSTR has an anti-proliferative effect on the NET. Hence they are found in greater amount in well-differentiated NETs. On the other hand de-differentiation increases metabolic activity in the tumour cells that amounts to greater <span class="elsevierStyleSup">18</span>F-FDG avidity in such tumors.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">68</span>Ga-DOTANOC PET/CT is a highly sensitive and specific modality for the detection of gastroenteropancreatic (GEP) NET. It has been shown to be better than conventional imaging modalities for the evaluation of GEP NETs and can have a significant impact on patient management.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The present case had mild <span class="elsevierStyleSup">68</span>Ga-DOTANOC uptake but significant <span class="elsevierStyleSup">18</span>F-FDG uptake justifying the high grade nature of GB NET (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-06" "fechaAceptado" => "2013-10-09" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2022 "Ancho" => 4514 "Tamanyo" => 645573 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">68</span>Ga-DOTANOC maximum intensity projection (MIP), CT and PET/CT images showing well-defined large gall bladder mass infiltrating into adjacent liver parenchyma with area of central necrosis and marginal uptake (SUVmax-20.5) of the radiotracer (A–C, arrow). <span class="elsevierStyleSup">18</span>F-FDG MIP, CT and PET/CT images of the same patient revealed intense FDG uptake (SUVmax-27.9) in the same gall bladder mass (D–F, arrow). Symmetric foci of uptake in neck and thorax were due to FDG uptake in brown fat tissue (D, dotted arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clear cell neuroendocrine tumor G1 of the gallbladder without von Hippel–Lindau disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Ishida" 1 => "H. Shiomi" 2 => "S. Naka" 3 => "T. Tani" 4 => "H. Okabe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/ol.2012.899" "Revista" => array:6 [ "tituloSerie" => "Oncol Lett" "fecha" => "2012" "volumen" => "4" "paginaInicial" => "1174" "paginaFinal" => "1176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23205114" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gallium-68-DOTA-NOC PET/CT of patients with gastroenteropancreatic neuroendocrine tumors: a prospective single-center study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Naswa" 1 => "P. Sharma" 2 => "A. Kumar" 3 => "A.H. Nazar" 4 => "R. Kumar" 5 => "S. Chumber" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2011" "volumen" => "197" "paginaInicial" => "1221" "paginaFinal" => "1228" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of <span class="elsevierStyleSup">68</span>Ga-DOTATATE and <span class="elsevierStyleSup">18</span>F-FDG PET/CT in pulmonary neuroendocrine tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Kayani" 1 => "B.G. Conry" 2 => "A.M. Groves" 3 => "T. Win" 4 => "J. Dickson" 5 => "M. Caplin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2967/jnumed.109.066639" "Revista" => array:6 [ "tituloSerie" => "J Nucl Med" "fecha" => "2009" "volumen" => "50" "paginaInicial" => "1927" "paginaFinal" => "1932" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19910422" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003300000005/v1_201408200020/S2253808914001232/v1_201408200020/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003300000005/v1_201408200020/S2253808914001232/v1_201408200020/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808914001232?idApp=UINPBA00004N" ]
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