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Incidental diagnosis of neuroendocrine tumor with 68Ga-PSMA PET/CT: Report of clinical case
Diagnóstico incidental de tumor neuroendocrino con 68Ga-PSMA PET/CT: A propósito de un caso
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B-D) Estudio inmunohistoquímico con positividad para anticuerpos CD56, sinaptofisina y Ki-67.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.I. Morales, A. Erhard, M.D. Lozano, G. Quincoces, J.A. Richter, M. Rodríguez-Fraile" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.I." "apellidos" => "Morales" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Erhard" ] 2 => array:2 [ "nombre" => "M.D." "apellidos" => "Lozano" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Quincoces" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "Richter" ] 5 => array:2 [ "nombre" => "M." 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"apellidos" => "Martín-Marcuartu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X19301982" "doi" => "10.1016/j.remn.2019.08.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X19301982?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919301193?idApp=UINPBA00004N" "url" => "/22538089/0000003900000002/v1_202002260643/S2253808919301193/v1_202002260643/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Incidental diagnosis of neuroendocrine tumor with <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT: Report of clinical case" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "102" "paginaFinal" => "103" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.I. Morales, A. Erhard, M.D. Lozano, G. Quincoces, J.A. Richter, M. Rodríguez-Fraile" "autores" => array:6 [ 0 => array:4 [ "nombre" => "M.I." "apellidos" => "Morales" "email" => array:1 [ 0 => "mmlozano@unav.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Erhard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.D." "apellidos" => "Lozano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Quincoces" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "J.A." "apellidos" => "Richter" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Rodríguez-Fraile" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Navarra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiofarmacia, Clínica Universidad de Navarra, Navarra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Clínica Universidad de Navarra, Navarra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico incidental de tumor neuroendocrino con <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT: A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1936 "Ancho" => 2508 "Tamanyo" => 495225 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Microscopic image of the FNB: A. Papanicolau staining: Cells in sheet with scarce cytoplasm and rounded nuclei with moderate anisocariosis, chromatin in fine lumps without prominent nucleolus and discrete reinforcement of the nuclear membrane. B, C, D. Immunohistochemical study with positivity for antibodies CD56, Synaptophysin and Ki67.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a case of a 82-year-old man diagnosed in 2013 of low-risk prostate cancer (PC) adenocarcinoma, Gleason 6 (3 + 3) located in the left prostate lobe, T2a, initial PSA of 6.26 ng/ml. He was treated with external radiotherapy according to the D’Amico classification modified by Zumsteg (T2, PSA < 10 ng/ml, Gleason 6). The total administered dose was 65.24 Gy, 95 % GTV in 28 fractions over the seminal vesicles and the prostate. Afterward, androgenic blockage was administered (nadir: 3.06 ng/ml). Despite the treatments received, the patient presented lymph node recurrence, treated again with external radiotherapy in 2017.</p><p id="par0010" class="elsevierStylePara elsevierViewall">At present, the patient was referred because of a suspected biochemical relapse (PSA=2.66 ng/ml, doubling time = 1.79 months and velocity = 0.01 ng/ml/month). However, a differential diagnosis between tumor recurrence and physiological elevation of PSA secondary to the increased levels of testosterone (5.28 ng/ml), was considered. For this reason, a <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT was performed. Seventy-six minutes after the intravenous injection of 161,32 MBq of <span class="elsevierStyleSup">68</span>Ga-PSMA, tomographic images were acquired on a Biograph mCT PET/CT (Siemens Healthineers Global) according to the OSEM Iter + TOF (3,21) reconstruction parameters.</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">68</span>Ga-PSMA uptake in a lymph node located in the retroperitoneum at the para-aortic location, suggestive of tumor infiltration, was detected. Furthermore, a lesion with intense uptake of the radiotracer was seen in the pancreatic body which was also suggestive of malignancy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A fine-needle biopsy (FNB) of the pancreatic lesion was performed and it resulted in a well-differentiated neuroendocrine tumor with a proliferation index Ki-67 of 1 % (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Since the approval of <span class="elsevierStyleSup">68</span>Ga-PSMA as a radiopharmaceutical product for the diagnosis and suspected recurrence of PC in Europe, many publications have reported its ability to incidentally detect non-prostatic tumors with PSMA-expression as renal carcinoma, well-differentiated thyroid carcinoma, lung adenocarcinoma or gastric/colonic adenocarcinoma. However, there is limited evidence about the expression of PSMA in neuroendocrine tumors, typically characterized by an increased tumoral neo-vascularization, which also express the prostate transmembrane glycoprotein (PSMA). In pancreatic localization, besides neuroendocrine tumors,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> benign lesions as the serous cystadenoma have shown <span class="elsevierStyleSup">68</span>Ga-PSMA uptake.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> That leads to consider these entities in the differential diagnosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As described by other authors,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> the incidental uptake of <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT hypothetically not related to the PC, supposes important changes in clinical management, being prioritized its treatment in some cases.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This case illustrates the importance of considering those incidental findings on <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT that might be due to synchronous tumors and suppose changes in the management of the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-06" "fechaAceptado" => "2019-08-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morales MI, Erhard A, Lozano MD, Quincoces G, Richter JA, Rodríguez-Fraile M. Diagnóstico incidental de tumor neuroendocrino con <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT: A propósito de un caso. Rev Esp Med Nucl Imagen Mol. 2020;39:102–103.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1538 "Ancho" => 2925 "Tamanyo" => 319653 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Maximum intensity projection <span class="elsevierStyleSup">68</span>Ga-PSMA PET/CT images in which is observed focal pancreatic uptake (blue arrow). B. Retroperitoneal, para-aortic lymph node uptake (SUVmax = 2,6) suggestive of nodal recurrence (blue arrow). C. Focal uptake in the pancreatic body (SUVmax = 6) related to a biopsy-confirmed neuroendocrine tumor (blue arrow).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1936 "Ancho" => 2508 "Tamanyo" => 495225 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Microscopic image of the FNB: A. Papanicolau staining: Cells in sheet with scarce cytoplasm and rounded nuclei with moderate anisocariosis, chromatin in fine lumps without prominent nucleolus and discrete reinforcement of the nuclear membrane. B, C, D. Immunohistochemical study with positivity for antibodies CD56, Synaptophysin and Ki67.</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" => "Prostate-Specific Membrane Antigen (PSMA) Avid Pancreatic Neuroendocrine Tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Vamadevan" 1 => "D. Shetty" 2 => "K. Le" 3 => "C. Bui" 4 => "R. Mansberg" 5 => "H. 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| Year/Month | Html | Total | |
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| 2023 April | 1 | 0 | 1 |
| 2021 March | 4 | 4 | 8 |
| 2020 March | 1 | 0 | 1 |
