Case report of a patient with initially inoperable well- differentiated midgut neuroendocrine tumor (WDNT) - PRRT and long-acting somatostatin analogs as the neoadjuvant therapy

A 43-year-old man was admitted to Surgery Department because of abdominal pain, vomiting, weight loss and flushes. Computed tomography (CT) examination revealed upper and middle abdomen tumor of about 110 × 110 mm. Histopathological analysis of the tissues obtained during the exploratory laparotomy confirmed WDNT (well-differentiated neuroendocrine tumor according to the WHO classification 2000). The patient received 5 doses of chemotherapy without any response. A positive result of 99mTc- [EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patient was treated with the total dose of 400 mCi of 90Y-DOTA-TATE. CT performed after the PRRT revealed regression of the tumor size to 72 × 94 mm. A decrease of CgA level and release of symptoms were also observed. Aiming at the removal of the considerable diminished tumor the patient was qualified for the second laparotomy. “Cytoreduction” surgery with partial excision of the tumor was performed. Additionally tumor-affected appendix was removed. The second focus of WDNT (according to the WHO classification 2000) with Ki67 < 1% was found in the appendix. Pathologists confirmed the above-mentioned lesions as independent (an extremely rare clinical situation). The following treatment with long-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATE resulted in further regression of the tumor size to 25 × 35 mm. Consecutive laparotomy is considered. If complete tumor removal might be achieved is an open question. The above case report shows the efficacy of combined therapy with the use of “hot” and “cold” somatostatin analogs not only in controlling the symptoms of the disease but also in obtaining tumor size regression making surgical intervention possible. Such a neoadjuvant therapy seems to be a promising tool in the management of patients with initially inoperable neuroendocrine tumors

Case report of a patient with initially inoperable well-differentiated midgut neuroendocrine tumor (WDNT) — PRRT and long-acting somatostatin analogs as the neoadjuvant therapy

A 43-year-old man was admitted to Surgery Department becauseof abdominal pain, vomiting, weight loss and flushes. Computedtomography (CT) examination revealed upper and middle abdomentumor of about 110 × 110 mm. Histopathological analysis ofthe tissues obtained during the exploratory laparotomy confirmedWDNT (well-differentiated neuroendocrine tumor according tothe WHO classification 2000). The patient received 5 doses ofchemotherapy without any response. A positive result of 99mTc-[EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patientwas treated with the total dose of 400 mCi of 90Y-DOTA-TATE.CT performed after the PRRT revealed regression of the tumorsize to 72 × 94 mm. A decrease of CgA level and release ofsymptoms were also observed. Aiming at the removal of theconsiderable diminished tumor the patient was qualified for thesecond laparotomy. “Cytoreduction” surgery with partial excisionof the tumor was performed. Additionally tumor-affected appendixwas removed. The second focus of WDNT (according to the WHOclassification 2000) with Ki67 &lt; 1% was found in the appendix. Pathologistsconfirmed the above-mentioned lesions as independent(an extremely rare clinical situation). The following treatment withlong-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATEresulted in further regression of the tumor size to 25 × 35 mm.Consecutive laparotomy is considered. If complete tumor removalmight be achieved is an open question. The above case reportshows the efficacy of combined therapy with the use of “hot” and“cold” somatostatin analogs not only in controlling the symptomsof the disease but also in obtaining tumor size regressionmaking surgical intervention possible. Such a neoadjuvant therapyseems to be a promising tool in the management of patients withinitially inoperable neuroendocrine tumors.A 43-year-old man was admitted to Surgery Department becauseof abdominal pain, vomiting, weight loss and flushes. Computedtomography (CT) examination revealed upper and middle abdomentumor of about 110 × 110 mm. Histopathological analysis ofthe tissues obtained during the exploratory laparotomy confirmedWDNT (well-differentiated neuroendocrine tumor according tothe WHO classification 2000). The patient received 5 doses ofchemotherapy without any response. A positive result of 99mTc-[EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patientwas treated with the total dose of 400 mCi of 90Y-DOTA-TATE.CT performed after the PRRT revealed regression of the tumorsize to 72 × 94 mm. A decrease of CgA level and release ofsymptoms were also observed. Aiming at the removal of theconsiderable diminished tumor the patient was qualified for thesecond laparotomy. “Cytoreduction” surgery with partial excisionof the tumor was performed. Additionally tumor-affected appendixwas removed. The second focus of WDNT (according to the WHOclassification 2000) with Ki67 &lt; 1% was found in the appendix. Pathologistsconfirmed the above-mentioned lesions as independent(an extremely rare clinical situation). The following treatment withlong-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATEresulted in further regression of the tumor size to 25 × 35 mm.Consecutive laparotomy is considered. If complete tumor removalmight be achieved is an open question. The above case reportshows the efficacy of combined therapy with the use of “hot” and“cold” somatostatin analogs not only in controlling the symptomsof the disease but also in obtaining tumor size regressionmaking surgical intervention possible. Such a neoadjuvant therapyseems to be a promising tool in the management of patients withinitially inoperable neuroendocrine tumors

Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome : experience of one Clinical Centre

PurposeEctopic Cushing Syndrome (EAS) is a rare condition responsible for about 5-20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production-especially neuroendocrine tumors with other neoplasms.MethodsTwenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed.ResultsHalf of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia.ConclusionEAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients

Biokinetics of ^{131}I after endogenous and exogenous stimulation of TSH in patients with DTC

BACKGROUND: The effective radioiodine treatment of patients with DTC is possible only after raising the TSH value over 30 μUI/ml. This effect might be obtained by either endogenous or exogenous stimulation. The aim of this study was to evaluate differences in 131I biokinetics of selected regions of interest (ROIs) in cases of endogenous and exogenous stimulation. MATERIAL AND METHODS: Two groups of 50 patients were enrolled in the study. All patients were treated with 3.7 GBq of 131I; the first group after thyroid hormone withdrawal (THW), the second group after rhTSH administration (rhTSH). On the basis of post-treatment images, the uptake ratios over selected ROIs (thyroid remnants, mediastinum, liver, stomach, abdomen, and whole-body) were compared between groups. RESULTS: In the case of uptake over the whole-body and the liver, statistically significant higher values were received for the THW group. For the remaining regions, the differences between groups were statistically insignificant, but uptake ratios in the rhTSH group were generally numerically lower compared to the THW group. CONCLUSIONS: The revealed difference in radioiodine biokinetics after thyroid hormone withdrawal or administration of recombinant human TSH may influence many important aspects of patients with DTC treatment, such as the choice of proper therapeutic scheme, the cost of therapy, and the dose assessment

Biokinetics of 131I after endogenous and exogenous stimulation of TSH in patients with DTC

BACKGROUND: The effective radioiodine treatment of patients with DTC is possible only after raising the TSH value over 30 &#956;UI/ml. This effect might be obtained by either endogenous or exogenous stimulation. The aim of this study was to evaluate differences in 131I biokinetics of selected regions of interest (ROIs) in cases of endogenous and exogenous stimulation. MATERIAL AND METHODS: Two groups of 50 patients were enrolled in the study. All patients were treated with 3.7 GBq of 131I; the first group after thyroid hormone withdrawal (THW), the second group after rhTSH administration (rhTSH). On the basis of post-treatment images, the uptake ratios over selected ROIs (thyroid remnants, mediastinum, liver, stomach, abdomen, and whole-body) were compared between groups. RESULTS: In the case of uptake over the whole-body and the liver, statistically significant higher values were received for the THW group. For the remaining regions, the differences between groups were statistically insignificant, but uptake ratios in the rhTSH group were generally numerically lower compared to the THW group. CONCLUSIONS: The revealed difference in radioiodine biokinetics after thyroid hormone withdrawal or administration of recombinant human TSH may influence many important aspects of patients with DTC treatment, such as the choice of proper therapeutic scheme, the cost of therapy, and the dose assessment. Nuclear Med Rev 2010; 13, 2: 55&#8211;5