Tektrotyd Scan Showing a Diffuse Bone Metastasis in Patient with a Neuroendocrine Pancreatic Tumor

Abstract

A 65-year-old woman presented with a neuroendocrine pancreatic head tumor and known liver and bone metastasis. We performed Tc-99m-tektrotyd scintigraphy on this patient, which showed more developed diffuse bone metastases, in addition to the known lesions.

A 65-year-old woman with pancreatic neuroendocrine tumor (NET) who has hepatic and skeletal metastases discovered with contrast-enhanced computed tomography. The patient underwent two full-body scans acquired 15 min and 3 h after intravenous injection of 740 MBq (20 mCi) of 99^mTc-ethylenediammonium diacetate- tricine-hydrazinonicotinamide-Tyr0- octreotide (Tektrotyd) which showing an intense uptake in the area of the head pancreatic mass, in the liver metastasis [Figure 1] and in diffuse bone metastasis interesting the axial and peripheral skeleton [Figure 2].

Figure 1.

Single-photon emission computed tomography-computed tomography (TEKTROTYD) showing an intense uptake in the area of the head pancreatic mass (upper image) and a large metastasis in the liver segment VI (lower image)

Figure 2.

Whole-body scan (anterior and posterior) diffuse bone metastasis

Pancreatic NETs are rare neoplasms that develop from the endocrine tissues of the pancreas. The reported incidence of 0.0003% to 0.001% of all cancers.[1,2,3] This incidence has been increasing throughout the world over the past two decades.[3,4] About 32%–73% of cases are metastatic at the moment of diagnosis.[4,5] The most common site of metastatic disease involvement for pancreatic NET is the liver.[6,7,8] Only 6%–13% of pancreatic NET patients will demonstrate skeletal metastasis.[9,10] Diffuse bone metastases in the entire axial and appendicular skeleton, as the case of our patient, are rare.[9,10,11,12,13,14] The European NET Society consensus guidelines recommend the use of both anatomic imaging, i.e. magnetic resonance imaging and functional whole-body imaging methods, including bone scintigraphy and somatostatin receptor scintigraphy (SRS), for the detection of bone metastases.[15] In the last few decades, the superior value of positron emission tomography/computed tomography (PET/CT) over SRS in the diagnosis of NENs, particularly after the introduction of 68Ga-DOTA-peptides that specifically bind to somatostatin receptors, has been widely demonstrated.[16] In our department, we do not have PET/CT that is why we use tektrotyd.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.