Case Author(s): Jayson R. St. Jacques,M.D. and Farrokh Dehdashti,M.D. , 10/18/02 . Rating: #D3, #Q4
Diagnosis: Neuroendocrine tumor in mediastinum.
Brief history:
74 year old woman with a left paratracheal mass.
Images:
3 plane FDG-PET images.
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View second image(ot).
Octreotide spect 3 plane views.
View third image(ct).
Axial CT of the chest images.
Full history/Diagnosis is available below
Diagnosis: Neuroendocrine tumor in mediastinum.
Full history:
74 year old woman with a left paratracheal mass that initially presented as difficulty in swallowing. Patient underwent CT scan of the chest followed by a transesophageal biopsy. The biospy demonstated a non-small cell lung cancer of neuroendocrine type.
PET scanning requested for initial staging.
Radiopharmaceutical:
3.7 mCi F-18 Fluorodeoxyglucose for FDG-PET, and
4.98 mCi In-111 pentetreotide i.v. (Octreotide)
Findings:
FDG-PET imaging demonstrated mildly increased uptake in the region of the paraesophageal mass noted on chest CT with no evidence of metastatic disease. Octreotide imaging was suggested as FDG-PET imaging has reduced sensitivity for neuroendocrine tumors compared to Octreotide.
Octeotide imaging demonstrates increased uptake within the same lesion without evidence of metastatic disease.
Discussion:
Neuroendocrine tumors are typically well differentiated with rare mitotic rate. The nuclear medicine study of choice for evaluating these tumors is In-111 Octeroscan. FDG-PET is only useful in evaluating less differentiated neuroendocrine tumors with high proliferative activity. Therefore, FDG-PET should be performed only if In-111 Octeroscan is negative.
Reference:
Adams et al., Eur J Nucl Med 1998; 25:79-83.
ACR Codes and Keywords:
References and General Discussion of PET Tumor Imaging Studies (Anatomic field:Lung, Mediastinum, and Pleura, Category:Neoplasm, Neoplastic-like condition)
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Case number: pt086
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