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Triple Tracer Positivity in Metastatic Lymph Nodes from Well-Differentiated Neuroendocrine Tumor in MEN-1 Syndrome

Anwin Joseph Kavanal, Sanjay K. Bhadada, Ashwani Sood, Gurjeet Kaur, Amber Parwaiz, Ajay Gulati, Divya Dahiya and Bhagwant Rai Mittal
Journal of Nuclear Medicine Technology September 2020, 48 (3) 287-289; DOI: https://doi.org/10.2967/jnmt.119.237339

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A and D) Early and delayed static images of 99mTc-sestamibi scintigraphy performed for hyperparathyroidism showing 2 foci of increased tracer uptake with retention near upper poles of both lobes of thyroid gland (solid arrows). (G and B) Early SPECT maximum-intensity projection image and coronal fused SPECT/CT image localizing increased tracer uptake in 2 lesions in posterosuperior location of both lobes of thyroid gland (solid arrows) suggestive of parathyroid adenomas. (A, B, D, E, G, and H) 99mTc-sestamibi planar and SPECT/CT images showing tracer avidity in the enlarged mediastinal and cervical lymph nodes (dashed arrows). (C, F, I, and J) Regional neck 18F-fluorocholine PET maximum-intensity projection image and cross-sectional fused PET/CT images showing tracer-avid lesions near upper poles of thyroid lobes, suggestive of bilateral superior parathyroid adenomas (solid arrows) along with intense tracer-avid enlarged mediastinal and cervical lymph nodes (dashed arrows).

  • FIGURE 2.
    FIGURE 2.

    (A) 68Ga-DOTANOC PET maximum-intensity projection image showing SSTR-expressing extensive metastatic disease of neuroendocrine origin. (B, E, G, and I) Transaxial fused 68Ga-DOTANOC PET/CT images showing intensely tracer-avid lesions in stomach and liver (B; solid and dashed arrows); cystic lesion in pancreas (E; arrow); and multiple enlarged lymph nodes in mediastinum (G) and cervical regions (I). (C, D, F, H, and J) 18F-FDG PET maximum-intensity projection image (D) and corresponding transaxial fused 18F-FDG PET/CT images (C, F, H, and J) showing low-grade 18F-FDG avidity in the above-mentioned lesions suggestive of well differentiated nature of the disease.

  • FIGURE 3.
    FIGURE 3.

    (A and B) Ultrasonography-guided fine-needle aspiration cytology from enlarged cervical lymph node revealing clusters of tumor cells with mildly pleomorphic nuclei, showing sudden anisonucleosis (May–Grünwald staining, ×20). (C) Additional cluster of tumor cells with stippled chromatin and moderate amount of cytoplasm (hematoxylin and eosin staining, ×20) suggestive of metastatic NET. (D) Immunocytochemistry for Ki-67 proliferation index was found to be less than 2%.

  • FIGURE 4.
    FIGURE 4.

    Whole-body anterior (A) and posterior (B) posttherapy images (177Lu-DOTATATE therapy; first cycle) showing tracer avidity in the lesions of metastatic neuroendocrine tumor.

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