ONCOLOGY, Ramos CD

Abstracts XIX Brazilian Congress of Nuclear Medicine

7. ONCOLOGY

7.9 - CARCINOID TUMOR WITHOUT [I-131]MIBG UPTAKE STUDIED WITH [F-18]FDG AND [In-111]OCTREOTIDE. A CASE REPORT.

Ramos CD, Sagarra A, Sagarra R, Etchebehere ECSC, Santos AO, Camargo EE. Division of Nuclear Medicine, Department of Radiology, Campinas State University (UNICAMP) and Division of Oncology, PUCC, Campinas, Brazil.

cdramos@mn-d.com

A 64 year old white female underwent left nephrectomy several years ago due to kidney stones. Carcinoid tumor was diagnosed 4.5 years ago during resection of an uterine myoma, with invasion of several organs. The pt underwent hysterectomy and sigmoidectomy. An IVP study performed 3.5 yrs ago detected a right sided hydronephrosis, interpreted as due to extrinsic compression. Exploratory laparotomy revealed hepatic invasion and peritoneal carcinomatosis. The patient developed intestinal sub-occlusion diagnosed at laparotomy and a colectomy was performed. Histopathology revealed intense desmoplastic reaction and microscopic foci of carcinoid tumor. Multiple, diffuse hepatic metastases measuring 10 to 12 mm, were visualized. A whole body [I-131]MIBG scintigraphy failed to detect any of the known lesions or other abnormalities. Two years ago the pt began a one year interferon-2-alfa treatment, with improvement of the heat waves, the diarrhea and the arthritic pain. The urinary levels of 5-OH-indolacetic acid decreased to the upper limits of the normal range. However, US of the abdomen showed enlargement of the hepatic lesions. Mammography revealed a focal lesion in the left breast diagnosed as carcinoid tumor by biopsy. Two months ago [F-18]FDG SPECT images in combination with [Tc-99m]sulfur colloid images showed multiple focal areas of increased tracer uptake in the base of the left lung, left breast, liver, ascending colon and left inferior quadrant of the abdomen. After 24 hours of the [F-18]FDG SPECT images, [In-111]octreotide SPECT images were performed and detected all the lesions seen with [F-18]FDG, with a better target-to-background ratio. [In-111]octreotide SPECT images also detected a lesion in the left parietal region, not demonstrated by any other method.