gallium-ga-68-dotatate and Carcinoma

In this case of suspected sphenoid wing meningioma, Ga-DOTATATE PET/CT showed a somatostatin receptor (SSR)-expressing tumor with extension to the nasopharynx and SSR-expressing cervical lymph nodes. Subsequent biopsy from the nasopharynx revealed an Epstein-Barr virus (EBV)-associated, undifferentiated World Health Organization type 3 nasopharyngeal carcinoma (NPC), a potential clinical pitfall due to the reported high SSR expression of this tumor subtype. In consideration of the high target-to-background contrast, SSR ligands might be superior to F-FDG for EBV-associated NPC PET imaging, particularly at the skull base. Somatostatin receptor ligands might furthermore offer interesting theranostic possibilities for patients with advanced/extensive EBV-associated NPC.

Topics: Adult; Carcinoma; Herpesvirus 4, Human; Humans; Male; Meningeal Neoplasms; Meningioma; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Differentiated thyroid carcinoma (DTC) has good prognosis but 5% of the patients already have distant metastasis at the diagnosis. Tumour cells can lose their iodine uptake ability and enter a state of dedifferentiation. Treatment for differentiated thyroid carcinoma that is not suitable for the local surgery and unresponsive to radioactive iodine uptake is not always easy for physicians. We present a case of a 64-year-old man who had total thyroidectomy surgery and central lymph node dissection with diagnosis of multinodular goitre disease. Histopathological evaluation was papillary thyroid cancer with tall cell variant. Treatment using 150 mCi radioiodine was administered to the patient three times but could not effect a cure. We performed Ga-68 labelled DOTATE (synthetic somatostatin analogue peptide). This provided a good outcome. As evident from our case, Lu-177 radionuclide labelled synthetic somatostatin analogue peptides have therapeutic effect on radioiodine refractory DTC, as an alternative treatment modality.

Topics: Aged; Carcinoma; Carcinoma, Papillary; Goiter, Nodular; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Octreotide; Organometallic Compounds; Peptides; Positron Emission Tomography Computed Tomography; Somatostatin; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy

Pituitary carcinoma is a rare disease with a challenge in both diagnosis and treatment. A 50-year-old female patient who underwent transsphenoidal resection of a pituitary tumor experienced progressive headache. For the evaluation, Ga DOTATATE PET/CT was used and compared with F-FDG PET/CT and enhanced MRI. Multiple lesions were detected by Ga DOTATATE PET/CT at the cerebral cortex, cerebellum, and cerebellopontine angle with a higher contrast than F-FDG PET/CT and enhanced MRI. With a biopsy, the patient was diagnosed as metastatic pituitary carcinoma. Moreover, it thus presents potential therapeutic implications on molecular-targeted therapy using somatostatin analogs and peptide receptor radionuclide therapy targeting the somatostatin receptors.

Topics: Brain Neoplasms; Carcinoma; Female; Humans; Middle Aged; Multimodal Imaging; Organometallic Compounds; Pituitary Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

A 68-year-old man, with a history of pituitary surgery and radiation therapy for pituitary macroadenoma 20 years earlier, presented with a pituitary mass and enlarging lesions within the posterior fossa and spinal canal. Biopsy revealed low-grade pituitary carcinoma. PET/CT scan showed multiple foci of increased Ga DOTATATE activity including pituitary and posterior fossa lesions. After 3 fractions of Lu DOTATATE therapy, the tumor remained stable over 4 years on MRI and Ga DOTATATE scans. This case illustrates the benefit of Ga DOTATATE PET/CT in malignant pituitary disease to assess potential for somatostatin receptor therapy with Lu DOTATATE and monitor treatment.

Topics: Aged; Carcinoma; Humans; Male; Multimodal Imaging; Octreotide; Organometallic Compounds; Pituitary Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

Thyroid diseases, which may occur as focal or diffuse changes in thyroid parenchyma, are most often observed in women.. Our aim was to assess the prevalence of incidental thyroid uptake of 68Ga-DOTATATE PET/CT in patients referred to the Nuclear Medicine Department for evaluation of neuroendocrine neoplasia (NEN).. We retrospectively evaluated 1150 68Ga-DOTATATE PET/CT images. Clinical history, serum TSH and thyroid antibody (TAb) concentrations, ultrasonography, and cytological assessment of the material from fine-needle aspiration biopsy (FNA) of the thyroid lesion were investigated.. We found incidental abnormalities in 46/1150 (4.1%) patients (12 men, 34 women). 34/46 patients (8 men, 26 women) showed diffuse 68Ga-DOTATATE thyroid uptake, with mean SUVmax 4.6 ± 1.6. Based on laboratory tests and ultrasound, we found: 38% of patients with an active autoimmune thyroiditis, 27% with benign goitre, and 6% with multinodular goitre with autoimmune thyroiditis. The remaining 29% of patients did not show any pathology. In 12/47 patients (4 men, 8 women) focal uptake in the thyroid with SUVmax 7.3 ± 3.3 was found. During one-year follow-up, category II and category III lesions (according to Bethesda classification) were revealed in 9/12 (75%) patients and in one patient, respectively. Histopathological examination after surgery revealed papillary thyroid carcinoma in one patient and benign multinodular goitre in another patient.. Patients with focal 68Ga-DOTATATE uptake should undergo further examination (FNA) due to potential risk of malignancy. Diffuse 68Ga-DOTATATE uptake was predominantly associated with active autoimmune thyroiditis or benign goitre. The focal lesions and diffuse pathology diseases were frequently seen in women.

Topics: Adult; Aged; Autoantibodies; Carcinoma; Carcinoma, Papillary; Female; Goiter, Nodular; Humans; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Retrospective Studies; Thyroid Cancer, Papillary; Thyroid Gland; Thyroid Hormones; Thyroid Neoplasms; Thyroiditis, Autoimmune

Somatostatin receptor (Sstr) scintigraphy with radiolabelled somatostatin analogues has been used extensively for the diagnosis and therapy of Sstr-expressing tumours. It has been shown that well-differentiated thyroid cancer (WDTC) cells have a high expression of Sstr2, Sstr3 and Sstr5. Hence, WDTC cells could be an ideal target for the evaluation of lesion uptake of Ga-68 DOTA-1-NaI3-octreotide (DOTA-NOC), which has a high affinity not only to Sstr2 but also to Sstr3 and Sstr5. The aim of the present study was to evaluate the value of Ga-68 DOTA-NOC as a target for Sstr2-expressing, Sstr3-expressing and Sstr5-expressing tumours in WDTC patients and to compare the results with those of Ga-68 DOTA-TATE in the same patient population.. Thirteen patients with WDTC were included in our study: nine with papillary thyroid cancer, three with Hurthle cell carcinoma and one with follicular thyroid carcinoma. All patients had elevated serum thyroglobulin levels and negative post-therapeutic I-131 whole-body scans, which were obtained after the last radioiodine treatment. All patients had undergone two consecutive PET imaging studies with Ga-68 DOTA-D-Phe1-Tyr3-octreotate (DOTA-TATE) and Ga-68 DOTA-NOC, respectively. All images were evaluated visually, and maximum standardized uptake values were calculated.. Both Ga-68 DOTA-TATE and Ga-68 DOTA-NOC PET images gave comparable results. Among the 13 patients, imaging with both Ga-68 DOTA-TATE and Ga-68 DOTA-NOC gave negative results in five (38%) patients and positive results in eight (62%) patients. A total of 45 lesions were identified on Ga-68 DOTA-TATE images and 42 on Ga-68 DOTA-NOC images; three lesions were missed. Lesion uptake was significantly higher on Ga-68 DOTA-TATE images. Maximum standardized uptake values of Ga-68 DOTA-TATE and Ga-68 DOTA-NOC were 12.9±9.1 and 6.3±4.1 (n=54, P<0.001), respectively.. Our study suggested that Ga-68 DOTA-TATE has a higher lesion uptake even in WDTC patients and may have potential advantage over Ga-68 DOTA-NOC.

Topics: Adenocarcinoma, Follicular; Adenoma, Oxyphilic; Adult; Aged; Antineoplastic Agents, Hormonal; Carcinoma; Carcinoma, Papillary; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Thyroid Cancer, Papillary; Thyroid Neoplasms; Tomography, X-Ray Computed