(dtpa-phe(1))-octreotide and Bronchial-Neoplasms

Secondary tumours of any type in the breast are rare. A review of the literature demonstrated only 23 cases of carcinoid tumours with associated breast metastasis, as distinct from primary carcinoid tumours of the breast. Distant metastases from carcinoid tumours are correlated with poor prognosis and survival. Although both primary and metastatic mammary carcinoid tumours are uncommon, the recognition of the true origin of the tumours may be of importance owing to the different clinical management and prognosis of the two conditions. Recently, radionuclide-labelled imaging techniques have been applied to the localization of such lesions, based on isotope uptake by receptors present in these neuroendocrine tumours. We report two new cases of carcinoid tumours with breast metastases, the primaries being in the ileocaecal valve and the bronchus, respectively. The diagnosis of a carcinoid tumour was based on the clinical, biochemical, histopathological and immunostaining features. Furthermore, these patients had both 123I-MIBG and 111In pentetreotide scintigraphy performed. These radionuclides play a useful role in the localization and potentially in the management of carcinoid tumours and their distant metastases.

Topics: 3-Iodobenzylguanidine; Adult; Antineoplastic Agents; Breast Neoplasms; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Ileal Neoplasms; Ileocecal Valve; Indium Radioisotopes; Iodine Radioisotopes; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals

Somatostatin receptor scintigraphy (SRS) has been used to diagnose bronchial carcinoids (BC) and is a valuable tool for accurate staging of BC. The aim of this study was to evaluate the role of SRS in restaging BC and following patients after treatment.. Thirty-one patients (18 male, 13 female) with confirmed BC who were referred during the last 7 years were included. Patients were examined via chest radiograph (12 studies), chest or abdominal computed tomography (CT; 28 scans), chest magnetic resonance imaging (2 scans), and liver ultrasound (5 scans).. Overall, in 22 patients (71%), SRS confirmed the data obtained by other diagnostic procedures (16 negative and 6 positive findings). In 6 patients, SRS showed focal lesions not previously demonstrated. In 2 patients, SRS resolved uncertain findings of CT. In 1 patient, SRS showed fewer lesions compared with CT. In 8 of 31 patients, important diagnostic information obtained by SRS was not revealed by any other imaging procedure.. Our results indicate that SRS is a reliable, noninvasive method that could be considered the principal follow-up procedure in patients with BC.

Topics: Adult; Aged; Bronchial Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Reproducibility of Results; Sensitivity and Specificity

Several authors proposed the stage at diagnosis and some histopathological features as prognostic factors of bronchial carcinoids. However, since large tumour diameters or nodal metastases are frequently associated to aggressive histology, their prognostic role is unclear. To investigate the relationships between the clinicopathological parameters at diagnosis and outcome, 21 patients were analysed. Overall 26% of the radically resected patients recurred. Recurrences and disease-specific mortality were related to atypical histology and, only in cases with typical histology, to the presence of hilar or mediastinal lymph node metastases. These prognostic factors were valuable independently of the size of the primary tumour, that was remarkably homogeneous, always less than 3 cm, thus not predictive of recurrence. Moreover we evaluated the role of somatostatin receptor scintigraphy, a diagnostic tool only preliminary studied in this field. Scintigraphy with 111In-octreotide revealed the primary tumours at diagnosis (8/8), the increase in tumour size in two unresected patients, and all the cases of recurrent or metastatic disease (5/11), sometimes before the appearance of symptoms. These results suggest the usefulness of histology and nodal status as prognostic factors in clinical practice. Somatostatin receptor scintigraphy turns out to be a powerful diagnostic tool, for an accurate staging and an early diagnosis of recurrence in bronchial carcinoids.

Topics: Adult; Aged; Bronchial Neoplasms; Carcinoid Tumor; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Male; Middle Aged; Octreotide; Pentetic Acid; Prognosis; Radionuclide Imaging

Topics: ACTH Syndrome, Ectopic; Adult; Bronchial Neoplasms; Carcinoid Tumor; Cushing Syndrome; Diagnosis, Differential; Humans; Indium Radioisotopes; Male; Octreotide; Pentetic Acid; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Surgery is the treatment of choice for bronchial carcinoid tumor (BCT), whenever the staging is adequate. There is little information about the capability of the somatostatin receptor scintigraphy (SRS) to detect bone metastases in the carcinoid tumor.. This work has aimed to evaluate retrospectively the diagnostic accuracy of the SRS in the detection of bone metastases in BCT.. Based on their clinical indication, the patients were classified into two different groups: Group A (n = 4), staging of a known BCT; and Group B (n = 6), treatment control. The SRS results could be correlated with the CT results in all 4 patients from the group A, and in one patient from the group B, and the SRS results were compared with the clinical follow up during at least one year in the other 5 patients.. The SRS scan detected the 4 BCT from the group A; in 2 of them the patient staging was superior when the SRS was used than with the CT, whereas the scan overestimated the tumor stage (BCT + sarcoidosis) in another patient. During the clinical course, one of these patients developed bone and liver metastases. The SRS was normal in 5 asymptomatic patients from group B, whereas the scan showed disseminated metastatic disease (liver, bone, spleen and lymph nodes) in another patient. In the 2 patients with bone metastases, the total number of bone metastases detected by the bone scan was 12, and by the SRS 8. The four lesions that were not detected by SRS were located in the ribs (n = 3) and 12-D (n = 1).. The capability of the SRS to detect bone metastases makes it more useful in BCT staging. Over the next few years, the role of the bone scan and SRS in the detection of bone metastases in carcinoid tumors needs to be established.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Proteins; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Bronchial carcinoid (BC) is a rare etiology of Cushing syndrome, and difficulties in differential diagnosis with Cushing's disease are often present. We report two cases in which octreotide scintigraphy was an important diagnostic tool. The first patient showed a 1 cm non-specific pulmonary nodule on CT scan that was positive on scintigraphy, being confirmed by surgery. The second case was a man that had been operated but not cured of an ACTH secreting BC that continued with high ACTH levels and negative localization imaging studies. A subsequent scintigraphy showed a positive image suggestive of recurrence. Octreotide scintigraphy may be considered in patients with suspicion of ectopic ACTH syndrome although a positive image in CT scan be present.

Topics: Aged; Bronchial Neoplasms; Carcinoid Tumor; Cushing Syndrome; Female; Humans; Male; Middle Aged; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals

We describe two cases of bronchial carcinoid tumour detected by (111In-DTPA-D-Phe1)-octreotide scintigraphy. The SPECT of the thoratic region provided a better images of the primary tumour than the planar images. In one of the patients, the bronchial carcinoid tumour was associated with sarcoidosis, which led to an erroneous evaluation of the extension of the tumour.

Topics: Adult; Biopsy; Bronchi; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Lung; Lung Diseases; Lymphatic Diseases; Middle Aged; Octreotide; Pentetic Acid; Radiography, Thoracic; Radiopharmaceuticals; Sarcoidosis; Terbium; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Bronchial carcinoid tumors are neuroendocrine neoplasms capable of expressing somatostatin receptors and of secreting neuromediators such as ACTH and chromogranins. Radiologic appearance is usually non-specific and has to be distinguished from benign pulmonary nodules and other malignant diseases. Standard radiological techniques have limited accuracy in the evaluation of such lesions. Radioisotopic imaging techniques may increase the specificity of diagnostic assessment. The role of immunoscintigraphy with anti-chromogranin A and B monoclonal antibodies (MoAbs) and of 111In-Octreoscan scintigraphy is evaluated in two cases of bronchial carcinoid tumors associated to Cushing syndrome.

Topics: Adolescent; Bronchial Neoplasms; Carcinoid Tumor; Chromogranin A; Chromogranins; Cushing Syndrome; Female; Humans; Indium Radioisotopes; Male; Octreotide; Pentetic Acid; Radioimmunodetection; Radiopharmaceuticals

Topics: ACTH Syndrome, Ectopic; Adult; Bronchial Neoplasms; Carcinoid Tumor; Humans; Indium Radioisotopes; Male; Octreotide; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals

Scintigraphy with radiolabelled analogue of somatostatin is highly sensitive in detecting carcinoid tumors especially if performed with Single Photon Computed Tomography (SPECT). In this report we describe our experience with 111In-DTPA-Octreotide in a female patient affected by a small asymptomatic intrabronchial carcinoid demonstrated by CT scan and bronchial endoscopy performed after recurrent left pneumonias. Planar views and SPECT images, using 111In-DTPA-Octreotide, were collected before and four hours after the first endoscopic laser resection. All groups of SPECT images were positive in the left parahilar region but at a different degree. Scans performed after resection showed a low degree of uptake which was considered to be probably secondary to local swelling; CT scan was negative. Follow up endoscopic biopsy repeated at six months, showed a relapse always in the same site; CT scan of the thorax was again negative. 111In-DTPA-Octreotide images obtained at twelve months were positive always in the left parahilar region, CT scan was negative but another biopsy was not possible. Therefore it was suspected a relapse of the carcinoid which was probably growing only through the bronchial wall without spreading towards the bronchial lumen and/or the lung parenchima. In this occasion, it was also thought that images collected four hours after resection could be positive not only for swelling but for a relapse as well. In every scintigraphic session, SPECT images presented higher quality than planar. This case suggests that 111In-DTPA-Octreotide SPECT is a non-invasive diagnostic technique which could be applied as a follow-up tool especially to patients with no-secreting carcinoid neoplasm and/or with negative or doubtful endoscopic and radiological investigations.

Topics: Adult; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Octreotide; Pentetic Acid; Tomography, Emission-Computed, Single-Photon