World Journal of Nuclear Medicine

INTERESTING CASES
Year
: 2021  |  Volume : 20  |  Issue : 3  |  Page : 324--326

Somatostatin-receptor avidity of pancreatic neuroendocrine tumor thrombus in porto-caval venous systems on 99mTc-Octreotide and posttherapeutic 177Lu-DOTA-TATE scans


Mahasti Amoui1, Reyhane Ahmadi2, Mohsen Qutbi1, Isa Neshandar Asli1,  
1 Department of Nuclear Medicine, School of Medicine, Shahid Beheshti University of Medical sciences, Tehran, Iran
2 Department of Nuclear Medicine and Molecular Imaging, Farshchian Heart Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

Correspondence Address:
Dr. Mohsen Qutbi
Department of Nuclear Medicine, Taleghani Hospital, Yaman Street, Velenjak, Tehran 1985711151
Iran

Abstract

A 62-year-old woman with a history of abdominal pain presented with multiple hepatic lesions and dilatation of portal, splenic and superior mesenteric veins on the magnetic resonance imaging referred for a 99mTc-octreotide scan. Accordingly, similar octreotide-avid lesions were found as well as an uptake in the epigastric region conforming to the anatomy of the portocaval venous system, compatible with a tumor thrombosis. Then, the patient underwent two cycles of therapy with 177Lu-DOTA-TATE, on that the same appearance was observed. The uptake in the tumor thrombus remained somewhat unchanged, but clinically, a significant improvement of the intractable ascites was achieved.



How to cite this article:
Amoui M, Ahmadi R, Qutbi M, Asli IN. Somatostatin-receptor avidity of pancreatic neuroendocrine tumor thrombus in porto-caval venous systems on 99mTc-Octreotide and posttherapeutic 177Lu-DOTA-TATE scans.World J Nucl Med 2021;20:324-326


How to cite this URL:
Amoui M, Ahmadi R, Qutbi M, Asli IN. Somatostatin-receptor avidity of pancreatic neuroendocrine tumor thrombus in porto-caval venous systems on 99mTc-Octreotide and posttherapeutic 177Lu-DOTA-TATE scans. World J Nucl Med [serial online] 2021 [cited 2022 Aug 11 ];20:324-326
Available from: http://www.wjnm.org/text.asp?2021/20/3/324/324172


Full Text

A 62-year-old woman with a history of abdominal pain, episodes of hypotension, and syncope presented for a 99mTc-octreotide scan. On the ultrasonography (USG) performed before, there were multiple heterogeneous and hypoechoic masses in hepatic parenchyma and significant dilatation and intraluminal thrombosis of the portal and splenic veins. Doppler USG also showed intrathrombotic vascular components suggestive of tumor thrombosis. The patient then underwent a gadolinium-enhanced magnetic resonance imaging (MRI) of the abdomen which confirmed multiple hypointense lesions in the liver and portal, splenic and superior mesenteric venous dilatation with heterogenous enhancement [Figure 1]. After receiving an informed consent, whole-body 99mTc-octreotide scan [Figure 2] was performed that demonstrated multiple octreotide-avid lesions in the liver as well as a less intense uptake in the epigastric region conforming to the anatomy of the portal and the splenic venous system as those found on the MRI. Afterward, the patient underwent a liver biopsy. Poorly differentiated neuroendocrine carcinoma of pancreatic origin was confirmed on histopathologic examination. The patient was on Sandostatin LAR treatment for several months before being referred for a radiopeptide therapy with 177Lu-DOTA-TATE as a result of exacerbation of the symptoms and developing intractable ascites. On post-therapeutic whole-body scan one day following intravenous administration of 5550 MBq [150 mCi] of 177Lu-DOTA-TATE [Figure 3]a, the same findings were observed as those on the 99mTc-octreotide scan. The patient received another dose of 177Lu-DOTA-TATE therapy 6 months later [Figure 3]b. The ascites improved remarkably by clinical assessment thereafter, but other lesions remained unchanged. Neuroendocrine tumors of pancreatic origin are among the tumors with a predilection for involvement of the portal and caval venous systems through the direct intraluminal extension of malignant tumoral cells. This mechanism is other than the predisposition toward the hypercoagulable state, i.e. venous thrombosis, induced by cancer. The former seems to be prognostically less favorable, because of predictably less response to anticoagulation therapy.[1],[2],[3] Unfortunately, since the uptake can be attributed to radiotracer accumulation either in the activated leukocytes trapped in the clot or malignant tumoral cells, octreotide-based scans seem not to be able to reliably differentiate the two conditions, but CT and MRI are more useful by demonstrating different enhancing patterns.[4],[5] The octreotide avidity of tumor thrombus has been shown in previous reports on 68Ga-DOTA-TATE/NOC positron emission tomography scans,[6],[7],[8],[9] but the response to 177Lu-DOTA-TATE therapy is yet to be investigated. Currently, the effective therapeutic method is surgical resection of the thrombus to alleviate the unpleasant symptoms.[10] In our case, because of the patient's refusal, surgical thrombectomy was not performed, but despite octreotide avidity of the thrombus, two cycles of 177Lu-DOTA-TATE therapy were not remarkably effective. However, a considerable clinical improvement in ascites has been observed, and therefore, this achievement, i.e. symptom alleviation, can be of notable importance. Taken together, further investigations are required to assess the effectiveness of radiopeptide therapy in resolving tumor thrombus from neuroendocrine tumors.{Figure 1}{Figure 2}{Figure 3}

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Conflicts of interest

There are no conflicts of interest.

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