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open access

Vol 69, No 3 (2018)
Case report
Submitted: 2018-03-28
Accepted: 2018-04-05
Published online: 2018-06-25
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TeleNEN as a telemedicine model for neuroendocrine neoplasm management in case of Meckel’s diverticulum NET

Jolanta Kunikowska1, Anna Zemczak2, Monika Górska1, Renata Matyskiel1, Maciej Słodkowski3, Izabela Łoń4, Beata Chrapko5, Beata Kos-Kudła26, Leszek Królicki1
DOI: 10.5603/EP.2018.0033
·
Pubmed: 29952421
·
Endokrynol Pol 2018;69(3):313-317.
Affiliations
  1. Nuclear Medicine Department, Medical University of Warsaw, Warsaw, Poland
  2. Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, Katowice, Poland
  3. Chair and Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
  4. Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
  5. Chair and Department of Nuclear Medicine, Medical University of Lublin, Lublin, Poland
  6. Division of Endocrinology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

open access

Vol 69, No 3 (2018)
Case report
Submitted: 2018-03-28
Accepted: 2018-04-05
Published online: 2018-06-25

Abstract

A case of 25- years-old female with NET deriving from Meckel’s diverticulum is described. The patient had one year history of dermatological skin problems. Ultrasound examination of abdomen performed because of arterial hypertension, revealed multiple hepatic lesions, which was confirmed in contrast enhanced CT. The typical contrast enhanced metastatic lesions in CT and elevated levels of chromogranin A suggested NET of unknown origin. SRS with 99mTc-HYNICTOC was perform for primary tumor localization, and revealed liver and paraaortic lymph nodes metastases, but no sign of primary tumor location. As a next step for primary tumor localization 68Ga-DOTATATE PET/CT was done, which revealed focus of increased uptake in small intestine considered to be the primary tumor site. The imaging and clinical history of patient was discussed on ENETS Tumor Board. Due to location of primary tumor in the small intestine with no anatomical changes in CT, laparotomy guided with gamma probe after 68Ga-DOTATATE injection was performed. During surgery procedure, the primary tumor was hardly palpable in the tip of Meckel’s diverticulum, confirmed by gamma probe. After surgery, tandem peptide receptor radionuclide therapy (PRRT) was started. Patient received 4 doses of 90Y/177Lu-DOTATATE with total activity of 360 mCi (13.32 GBq). The three months follow up 68Ga-DOTATATE PET/CT had shown stable disease of patient. The presented case showed importance role of multidisciplinary team cooperation in patient management. Use of RGS is essential in cases like presented, when the tumor cannot be localized only by surgical palpation.

Abstract

A case of 25- years-old female with NET deriving from Meckel’s diverticulum is described. The patient had one year history of dermatological skin problems. Ultrasound examination of abdomen performed because of arterial hypertension, revealed multiple hepatic lesions, which was confirmed in contrast enhanced CT. The typical contrast enhanced metastatic lesions in CT and elevated levels of chromogranin A suggested NET of unknown origin. SRS with 99mTc-HYNICTOC was perform for primary tumor localization, and revealed liver and paraaortic lymph nodes metastases, but no sign of primary tumor location. As a next step for primary tumor localization 68Ga-DOTATATE PET/CT was done, which revealed focus of increased uptake in small intestine considered to be the primary tumor site. The imaging and clinical history of patient was discussed on ENETS Tumor Board. Due to location of primary tumor in the small intestine with no anatomical changes in CT, laparotomy guided with gamma probe after 68Ga-DOTATATE injection was performed. During surgery procedure, the primary tumor was hardly palpable in the tip of Meckel’s diverticulum, confirmed by gamma probe. After surgery, tandem peptide receptor radionuclide therapy (PRRT) was started. Patient received 4 doses of 90Y/177Lu-DOTATATE with total activity of 360 mCi (13.32 GBq). The three months follow up 68Ga-DOTATATE PET/CT had shown stable disease of patient. The presented case showed importance role of multidisciplinary team cooperation in patient management. Use of RGS is essential in cases like presented, when the tumor cannot be localized only by surgical palpation.

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Keywords

Meckel neuroendocrine tumour, 68Ga-DOTATATE, 99mTc-HYNICTOC, 90Y/177Lu-DOTATATE, tandem PRRT

About this article
Title

TeleNEN as a telemedicine model for neuroendocrine neoplasm management in case of Meckel’s diverticulum NET

Journal

Endokrynologia Polska

Issue

Vol 69, No 3 (2018)

Article type

Case report

Pages

313-317

Published online

2018-06-25

Page views

2567

Article views/downloads

1188

DOI

10.5603/EP.2018.0033

Pubmed

29952421

Bibliographic record

Endokrynol Pol 2018;69(3):313-317.

Keywords

Meckel neuroendocrine tumour
68Ga-DOTATATE
99mTc-HYNICTOC
90Y/177Lu-DOTATATE
tandem PRRT

Authors

Jolanta Kunikowska
Anna Zemczak
Monika Górska
Renata Matyskiel
Maciej Słodkowski
Izabela Łoń
Beata Chrapko
Beata Kos-Kudła
Leszek Królicki

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