title: Use of radioguided surgery with [111In]-pentetreotide in the management of an ACTH-secreting bronchial carcinoid causing ectopic Cushing's syndrome.
abstract: Intraoperative [111In]-pentetreotide scintigraphy with a hand-held gamma detector probe has recently been proposed to increase the intraoperative detection rate of small neuroendocrine tumors and their metastases. We report a case of a 28-yr-old woman with ectopic Cushing's syndrome due to an ACTH-secreting bronchial carcinoid, in whom the use of radioguided surgery improved disease management. At presentation, radiolabeled pentetreotide scintigraphy was the only procedure able to detect the ectopic source of ACTH. After radiologic confirmation, the patient underwent removal of a bronchial carcinoid, with disease persistence. After surgery, pentetreotide scintigraphy showed pathologic uptake in the mediastinum not previously detected at surgery and only subsequently confirmed by radiologic studies. Despite a second thoracic exploration, hormonal, scintigraphic, and radiological evidence of residual disease persisted. Radioguided surgery was then performed using a hand-held gamma probe 48 h after iv administration of a tracer dose of radiolabeled [111In-DTPA-D-Phe1]-pentetreotide, which permitted detection and removal of multiple residual mediastinal lymph node metastases. Clinical and radiologic cure, with no evidence of tracer uptake at pentetreotide scintigraphy, was subsequently observed. The use of an intraoperative gamma counter appears a promising procedure in the management of metastatic ACTH-secreting bronchial carcinoids.
authors.affiliation: Surgery Niguarda Hospital, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Grossrubatscher
authors.forename: F
authors.initials: F
authors.lastname: Vignati
authors.forename: P
authors.initials: P
authors.lastname: Dalino
authors.forename: M
authors.initials: M
authors.lastname: Possa
authors.forename: P A
authors.initials: PA
authors.lastname: Belloni
authors.forename: A
authors.initials: A
authors.lastname: Vanzulli
authors.forename: M
authors.initials: M
authors.lastname: Bramerio
authors.forename: A
authors.initials: A
authors.lastname: Marocchi
authors.forename: O
authors.initials: O
authors.lastname: Rossetti
authors.forename: F
authors.initials: F
authors.lastname: Zurleni
authors.forename: P
authors.initials: P
authors.lastname: Loli
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D015415:Biomarkers; D001984:Bronchial Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002276:Carcinoid Tumor / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D003346:Corticotropin-Releasing Hormone; D003480:Cushing Syndrome / Q000209:etiology*; D003894:Deamino Arginine Vasopressin; D005260:Female; D006728:Hormones / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008163:Luminescent Measurements; D008207:Lymphatic Metastasis; D008479:Mediastinal Neoplasms / Q000601:surgery; D015282:Octreotide; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013004:Somatostatin / Q000031:analogs & derivatives*; D013268:Stimulation, Chemical; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D006728:Hormones; D019275:Radiopharmaceuticals; D013004:Somatostatin; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D003894:Deamino Arginine Vasopressin; C081788:pentetreotide; D015282:Octreotide; D006854:Hydrocortisone