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PHEOCHROMOCYTOMA
Authored By: Shane Inoue and Jerold Wallis, Assoc Prof of Radiology.
Patient: 47 year old female
History: 47-year-old woman with a retroperitonal mass and a right lower lobe lung mass which reportedly demonstrates increased uptake on outside hospital PET examination.

What type of scan is this?

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Note the mildly increased uptake in the salivary glands, the only minimal splenic and renal uptake, and the location of the retroperitoneal uptake to provide a clue as to tracer type.
Image Size:[small][as-submitted]

Fig. 1
Whole body MIBG
Image Size:[small][as-submitted]

Findings: 1. Intense uptake within the region of the left adrenal gland correlating with left adrenal mass and indicative of a left adrenal pheochromocytoma.

2. No tracer uptake within the thorax to correlate with reported right lower lobe lung mass seen on outside hospital imaging (which is not available for direct correlation).

3. Mild tracer uptake within the right adrenal gland. While this may be within normal limits, correlation with outside hospital cross-sectional imaging and PET examination studies is recommended.
Diagnosis: Pathology demonstrated an adrenal pheochromocytoma with vascular invasion.  No further workup of the right adrenal gland was performed.  Subsequent metanephrine levels normalized following surgery.
General Discussion: Tracer:  I-123 MIBG (Meta-iodobenzylguanidine).  

Abnormal MIBG uptake coupled with elevated plasma metanepherine and normetanephrine levels are consistent with a pheochromocytoma.

This type of tumor could also be imaged with In-111 Octreotide, but that tracer would have also shown intense splenic and renal uptake of tracer.

In most cases, faint cardiac activity can also be seen on MIBG scans.  This is not the case here, likely due to the large amount of functioning tumor with intense tracer uptake.
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Additional Details:

Case Number: 130879Owner(s): Shane Inoue and Jerold Wallis, Assoc Prof of RadiologyLast Updated: 02-07-2013
Anatomy: Genitourinary (GU)   Pathology: Neoplasm
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: pheochromocytoma

Case has been viewed 48 times.
Certified by Jerold Wallis on 06-24-2009

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