PMC9483167_01
Positron emission tomography/computed tomography (PET/CT) images with Gallium-68 [68Ga]-labeled dodecanetetraacetic acid-tyrosine-3-octreotate ([68Ga]-DOTA-TATE) and Fluor-18 [18F]-fluorodeoxyglucose ([18F]-FDG). (A) The maximum intensity projection (MIP) images summarize the physiological and pathological distribution of [68Ga]-DOTA-TATE in the body. (B) PET/CT scan showed multiple mediastinal lymphatic nodes (blue dotted arrow) and widespread bone metastases with significant uptake of [68Ga]-DOTA-TATE. (C) [68Ga]-DOTA-TATE-positive bone metastasis in the left iliac wing (white arrow). (D) [68Ga]-DOTA-TATE-negative solid mass in the left ovary (red arrow). (E) The MIP images summarize the physiological and pathological distribution of [18F]-FDG in the body. (F) Multiple [68Ga]-DOTA-TATE-positive metastases in mediastinal lymphatic nodes (blue dotted arrow). (G) The axial PET/CT image demonstrated low [18F]-FDG uptake in the bone metastasis in the left iliac wing (white arrow). (H) The axial slice of [18F]-FDG PET/CT showed high [18F]-FDG uptake in the solid mass in the left ovary (red arrow).
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MBq of radiopharmaceutical. PET/CT scan showed multiple mediastinal lymphatic nodes, and widespread bone metastases with significant uptake of [68Ga]-DOTA-TATE ( Figures 1A-C ). Moreover, PET/CT revealed [68Ga]-DOTA-TATE negative solid mass in the left ovary (size 34x30x47 mm) (Figure 1D), peritoneal implants, and enlarged right cervical lymphatic node. H), peritoneal implants (SUV max= 1,54), right cervical lymphatic node (SUV max= 3,91), and several mediastinal lymphatic nodes (SUV max= 3,67) ( Figures 1E, F ). However, we observed accumulation of [18F]-FDG in only a few bone metastases ( Figure 1G ).
Histological and immunohistochemical examination of primary neuroendocrine tumor of the left ovary. (A) Hematoxylin and eosin staining x50. (B) CD56 x50. (C) ACTH x50. (D) GLUT-1 x100. (E) SSTR 5 subtype x200.
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GLUT-1 overexpression was seen in 85% of the tumor cells ( Figure 2 ).
PET/CT images with [68Ga]-DOTA-TATE and [18F]-FDG. (A) The maximum intensity projection (MIP) images summarize the physiological and pathological distribution of [68Ga]-DOTA-TATE in the body. PET/CT scan showed an increase in the size of the previously detected metastases and the appearance of a new mediastinal lymph node and bone metastases. (B) [68Ga]-DOTA-TATE. PET/CT revealed an avid metastatic lesion in the upper inner quadrant of the left breast (white arrow). (C) The MIP images of [18F]-FDG PET showed intense tracer uptake in the same area as the [68Ga]-DOTA-TATE PET/CT scan. (D) [18F]-FDG-positive metastatic lesion in the left breast (white arrow).
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This showed an increase in the size of the previously detected metastases and the appearance of a new mediastinal lymph node and bone metastases, while the radiopharmaceutical uptake did not have a significantly effect ( Figure 3A ). However, the follow-up [68Ga]-DOTATATE PET/CT scan now showed an avid metastatic lesion in the upper inner quadrant of the left breast ( Figure 3B ) that was not visualized during the previous PET/CT scans. An [18F]-FDG PET/CT scan showed intense tracer uptake in the same area as the [68Ga]-DOTA-TATE PET/CT scan, indicating left breast metastasis of the ovarian NET ( Figures 3C, D ).
Histological and immunohistochemical examination of a metastatic lesion in the left breast. (A) Hematoxylin and eosin staining x200. (B) Synaptophysin x200. (C) ACTH x200. (D) GLUT-1 x200. (E) SSTR 5 subtype x200. (F) Ki-67 x200.
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Immunocytochemistry showed the expression of chromogranin A, synaptophysin, NSE, and ACTH, and the Ki-67 index was 15% ( Figure 4 ). The majority of the tumor cells expressed the somatostatin receptor 5 subtype ( Figure 4E ).