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      Somatostatin receptor molecular imaging in a misdiagnosed gastrinoma case

      case-report

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          Abstract

          Gastrin-secreting tumors, hypergastrinemia and severe ulcer disease form the trademarks of Zollinger-Ellison syndrome (ZES). We report a case of gastrinoma, in a patient who was misdiagnosed for almost five years. The case emphsizes the the special role of functional imaging in the personalized approach to the patient with suggestive symptomatology for NETs. Taking into account that in 80 to 100% of cases of gastroenteropancreatic (GEP) NETs are expressing somatostatin receptors, the functional imaging with radiolabeled somatostatin analogues can be used in order to improve its diagnosis, respectively the treatment of GEP NETs. In the approach to the patient with tremendous digestive symptomatology, physicians from different specialties should evaluate NETs specific markers and then insist on structural-functional complementarity, avoiding the waste of time and high cost of repeated structural investigations. The conclusion of our study is that functional imaging is mandatory in the diagnostic algorithm of gastrinoma.

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          Chromogranin A – unspecific neuroendocrine marker. Clinical utility and potential diagnostic pitfalls

          Paweł Gut, Agata Czarnywojtek, Jakub Fischbach … (2016)
          Chromogranin A, despite a number of limitations, is still the most valuable marker of neuroendocrine tumors (NETs). Granins belong to the family of acidic proteins that constitute a major component of secretory granules of various endocrine and neuroendocrine cells, which are components of both the classical endocrine glands and the diffuse neuroendocrine system. These cells are a potential source of transformation into neuroendocrine tumors. The awareness of potential causes influencing the false results of its concentrations simplifies diagnosis and treatment. One of the disadvantages of this marker is its non-specificity and the existence of a number of pathological processes leading to an increase in its concentration, which often results in confusion and diagnostic difficulties. The molecular structure is characterized by a number of sites susceptible to the proteolytic activity of enzymes, resulting in the formation of a number of biologically active peptides. Presumably they act as precursors of active proteins. Chromogranin expression correlates with the amount of secretory vesicles in neuroendocrine cells. The peptide chain during biochemical changes becomes a precursor of biologically active proteins with a wide range of activities. There are a number of commercially available kits for the determination of chromogranin A, which differ in methodology. We present the evaluation of chromogranin A as a marker of neuroendocrine tumors in clinical practice and the possible factors that may affect the outcome of its concentration.
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            Somatostatin receptor PET ligands - the next generation for clinical practice.

            Elin Pauwels, Frederik Cleeren, Guy Bormans … (2018)
            Somatostatin receptors (SSTRs) are variably expressed by a variety of malignancies. Using radiolabeled somatostatin analogs (SSAs), the presence of SSTRs on tumor cells may be exploited for molecular imaging and for peptide receptor radionuclide therapy. 111In-DTPA-octreotide has long been the standard in SSTR scintigraphy. A major leap forward was the introduction of gallium-68 labeled SSAs for positron emission tomography (PET) offering improved sensitivity. Tracers currently in clinical use are 68Ga-DOTA-Tyr3-octreotide (68Ga-DOTATOC), 68Ga-DOTA-Tyr3-octreotate (68Ga-DOTATATE) and 68Ga-DOTA-1-NaI3-octreotide (68Ga-DOTANOC), collectively referred to as 68Ga-DOTA-peptides. 68Ga-DOTA-peptide PET has superseded 111In-DTPA-octreotide scintigraphy as the modality of choice for SSTR imaging. However, implementation of 68Ga-DOTA-peptides in routine clinical practice is often limited by practical, economical and regulatory factors related to the use of the current generation of 68Ge/68Ga generators. Centralized production and distribution is challenging due to the low production yield and relatively short half-life of gallium-68. Furthermore, gallium-68 has a relatively long positron range, compromising spatial resolution on modern PET cameras. Therefore, possibilities of using other PET radionuclides are being explored. On the other hand, new developments in SSTR PET ligands are strongly driven by the need for improved lesion targeting, especially for tumors with low SSTR expression. This may be achieved by using peptide vectors having a higher affinity for the SSTR or a broader affinity profile for the different receptor subtypes or by using compounds recognizing more binding sites, such as SSTR antagonists. This review gives an overview of recent developments leading to the next generation of clinical PET tracers for SSTR imaging.
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              Imaging of neuroendocrine tumors of the pancreas

              C Dromain, D Deandreis, J-Y Scoazec … (2016)
              Article 0 comments Cited 22 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Nucl Med
                Journal ID (iso-abbrev): World J Nucl Med
                Journal ID (publisher-id): WJNM
                Title: World Journal of Nuclear Medicine
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 1450-1147
                ISSN (Electronic): 1607-3312
                Publication date Collection: Oct-Dec 2020
                Publication date (Electronic): 22 August 2020
                Volume: 19
                Issue: 4
                Pages: 417-420
                Affiliations
                [1 ]Department of Biophysics and Medical Physics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
                [2 ]Nuclear Medicine Laboratory, “ST. Spiridon” Emergency County Hospital, Iasi, Romania
                [3 ]Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
                [4 ]Center for Nuclear Medicine, Clinical Center Kragujevac, Kragujevac, Serbia
                Author notes
                Address for correspondence: Dr. Irena Cristina Grierosu, Department of Biophysics and Medical Physics, “Grigore T. Popa” University of Medicine and Pharmacy, University Street No. 16, Iasi, 700115, Romania. E-mail: irena.raileanu@ 123456umfiasi.ro
                Article
                Publisher ID: WJNM-19-417
                DOI: 10.4103/wjnm.WJNM_16_20
                PMC ID: 7875036
                SO-VID: 3a9ec06a-5a93-4664-8f67-37550f2b9293
                Copyright © Copyright: © 2020 World Journal of Nuclear Medicine
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 12 February 2020
                Date revision received : 08 April 2020
                Date accepted : 01 May 2020
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: functional imaging,gastrinoma,hypergastrinemia,neuroendocrine tumors,somatostatin receptor scintigraphy
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: functional imaging, gastrinoma, hypergastrinemia, neuroendocrine tumors, somatostatin receptor scintigraphy

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