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Furr T, Grodman B, Heffernan J. Rare case of mortality after hemorrhagic property of esthesioneuroblastoma. Arch Clin Cases 2023; 10:175-178. [PMID: 38098697 PMCID: PMC10719983 DOI: 10.22551/2023.41.1004.10269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Esthesioneuroblastoma is a tumor arising from olfactory neuroepithelium with an incidence of four per million. This case presents a rare nasal cavity neoplasm with hemorrhagic properties that may lead to significant sequelae. We present a 69-year-old male patient who presented with worsening altered mental status over the past 6-7 months. His Glasgow coma scale was a nine, showing a large mass centered at the cribriform plate with extension intracranially, sinonasal cavity, and bilateral orbits on diagnostics. Bifrontal craniotomy was performed one day after admission with resection of the tumor in the cranial fossa and intranasally, and decompression of the brainstem, frontal lobes, and third ventricle. After surgery, the patient was managed in the intensive care unit but continued to deteriorate. He was confirmed to have no meaningful brain activity and eventually deceased seven days after admission. Depending on the tumor stage, esthesioneuroblastoma can have a favorable prognosis with proper therapies. Different surgical techniques for ENB lead to the question of which therapeutic modality is the best because of the tumor's gross hemorrhagic properties. With adjunctive radiation therapy and/or chemotherapy, more research can bring light to proper surgical techniques.
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Affiliation(s)
- Todd Furr
- School of Medicine, American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten, Netherlands Antilles
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2
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Agarwal A, Bhatt AA, Bathla G, Kanekar S, Soni N, Murray J, Vijay K, Vibhute P, Rhyner PH. Update from the 5th Edition of the WHO Classification of Nasal, Paranasal, and Skull Base Tumors: Imaging Overview with Histopathologic and Genetic Correlation. AJNR Am J Neuroradiol 2023; 44:1116-1125. [PMID: 37591773 PMCID: PMC10549938 DOI: 10.3174/ajnr.a7960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 08/19/2023]
Abstract
Sinonasal and skull base tumors are a heterogeneous group of neoplasms with considerable histologic variation and overlapping imaging features. In 2022, the World Health Organization updated the head and neck tumor classification, further emphasizing the importance of molecular data and genetic alterations in sinonasal neoplasms. The changes include the addition of new entities and discussion of emerging entities, as well as changes to the taxonomy and characterization of tumors. The new classification focuses on entities that develop in these sites either exclusively (eg, olfactory neuroblastoma) or most frequently. Another change includes reduction in the number of categories by creating separate category-specific chapters for soft-tissue, hematolymphoid, and neuroectodermal lesions. In this review, we briefly discuss the various categories in the new classification with a more detailed description of the 2 new entities (SWItch/Sucrose Non-Fermentable complex-deficient sinonasal carcinomas and human papillomavirus-related multiphenotypic sinonasal carcinoma). We also highlight the emerging entities including IDH-mutant sinonasal malignancies and DEK-AFF2 carcinoma, presently classified as sinonasal undifferentiated carcinoma and nonkeratinizing squamous cell carcinoma, respectively.
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Affiliation(s)
- A Agarwal
- From the Department of Radiology (A.A., J.M., P.V., P.H.R.), Mayo Clinic, Jacksonville, Florida
| | - A A Bhatt
- Department of Radiology (G.B.), Mayo Clinic, Rochester, Minnesota
| | - G Bathla
- From the Department of Radiology (A.A., J.M., P.V., P.H.R.), Mayo Clinic, Jacksonville, Florida
| | - S Kanekar
- Penn State University Health System (S.K.), Hershey, Pennsylvania
| | - N Soni
- Department of Radiology (N.S.), University of Rochester Medical Center, Rochester, New York
| | - J Murray
- Department of Neuroradiology (J.M., P.V., P.H.R.), Mayo Clinic, Jacksonville, Florida
| | - K Vijay
- Department of Radiology (K.V.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Vibhute
- Department of Neuroradiology (J.M., P.V., P.H.R.), Mayo Clinic, Jacksonville, Florida
| | - P H Rhyner
- Department of Neuroradiology (J.M., P.V., P.H.R.), Mayo Clinic, Jacksonville, Florida
- Department of Radiology (K.V.), University of Texas Southwestern Medical Center, Dallas, Texas
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3
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Rini JN, Keir G, Caravella C, Goenka A, Franceschi AM. Somatostatin Receptor-PET/CT/MRI of Head and Neck Neuroendocrine Tumors. AJNR Am J Neuroradiol 2023; 44:959-966. [PMID: 37442593 PMCID: PMC10411831 DOI: 10.3174/ajnr.a7934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND AND PURPOSE Due to its high sensitivity, somatostatin receptor-PET may detect smaller lesions and more extensive disease than contrast-enhanced MR imaging, while the superior spatial resolution of MR imaging enables lesions to be accurately localized. We compared results of somatostatin receptor-PET/MRI with those of MR imaging alone and assessed the added value of vertex-to-thigh imaging for head and neck neuroendocrine tumors. MATERIALS AND METHODS Somatostatin receptor-PET/CT was acquired as limited brain or head and neck imaging, with optional vertex-to-thigh imaging, following administration of 64CU/68GA DOTATATE. Somatostatin receptor-PET was fused with separately acquired contrast-enhanced MR imaging. DOTATATE activity was classified as comparable, more extensive, and/or showing additional lesions compared with MR imaging. Vertex-to-thigh findings were classified as positive or negative for metastatic disease or incidental. RESULTS Thirty patients (with 13 meningiomas, 11 paragangliomas, 1 metastatic papillary thyroid carcinoma, 1 middle ear neuroendocrine adenoma, 1 external auditory canal mass, 1 pituitary carcinoma, 1 olfactory neuroblastoma, 1 orbital mass) were imaged. Five had no evidence of somatostatin receptor-positive lesions and were excluded. In 11/25, somatostatin receptor-PET/MRI and MR imaging were comparable. In 7/25, somatostatin receptor-PET/MRI showed more extensive disease, while in 9/25, somatostatin receptor-PET/MRI identified additional lesions. On vertex-to-thigh imaging, 1 of 17 patients was positive for metastatic disease, 8 of 17 were negative, and 8 of 17 demonstrated incidental findings. CONCLUSIONS Somatostatin receptor-PET detected additional lesions and more extensive disease than contrast-enhanced MR imaging alone, while vertex-to-thigh imaging showed a low incidence of metastatic disease. Somatostatin receptor-PET/MRI enabled superior anatomic delineation of tumor burden, while any discrepancies were readily addressed. Somatostatin receptor-PET/MRI has the potential to play an important role in presurgical and radiation therapy planning of head and neck neuroendocrine tumors.
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Affiliation(s)
- J N Rini
- From the Nuclear Medicine Division (J.N.R., G.K., C.C.), Department of Radiology
| | - G Keir
- From the Nuclear Medicine Division (J.N.R., G.K., C.C.), Department of Radiology
| | - C Caravella
- From the Nuclear Medicine Division (J.N.R., G.K., C.C.), Department of Radiology
| | - A Goenka
- Department of Radiation Oncology (A.G.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - A M Franceschi
- Neuroradiology Division (A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
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Akay S, Pollard JH, Saad Eddin A, Alatoum A, Kandemirli S, Gholamrezanezhad A, Menda Y, Graham MM, Shariftabrizi A. PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms. Cancers (Basel) 2023; 15:3759. [PMID: 37568575 PMCID: PMC10417627 DOI: 10.3390/cancers15153759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.
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Affiliation(s)
- Sinan Akay
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Janet H. Pollard
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Assim Saad Eddin
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Aiah Alatoum
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Sedat Kandemirli
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90030, USA
| | - Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Michael M. Graham
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ahmad Shariftabrizi
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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Thompson LDR, Bishop JA. Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Nasal Cavity, Paranasal Sinuses and Skull Base. Head Neck Pathol 2022; 16:1-18. [PMID: 35312976 PMCID: PMC9018924 DOI: 10.1007/s12105-021-01406-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 12/31/2022]
Abstract
The World Health Organization Classification of Head and Neck Tumours recently published the 5th edition. There are new entities, emerging entities, and significant updates to the taxonomy and characterization of tumor and tumor-like lesions, specifically in this article as it relates to nasal cavity, paranasal sinuses and skull base. Importantly, the number of diagnostic entries has been reduced by creating category-specific chapters for soft tissue, hematolymphoid, melanocytic, neuroectodermal, and metastatic tumors. Bone and salivary gland tumors are also not separately reported in the sinonasal tract, but included in the jaw and salivary gland sections, respectively. Repetition of characteristic entities in each anatomic site was also reduced, instead highlighting only the unique features in each anatomic site. Two new entities (SWI/SNF complex-deficient sinonasal carcinomas and HPV-related multiphenotypic sinonasal carcinoma) will be highlighted in this review, with a discussion of several emerging entities. There is a short description of updated information for all 24 diagnostic entities included in this edition to allow the reader a snapshot of current state of knowledge, but to encourage more investigation and further broaden understanding of these diverse and rare entities.
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Affiliation(s)
- Lester D. R. Thompson
- Head and Neck Pathology Consultations, 22543 Ventura Boulevard, Ste 220 PMB1034, Woodland Hills, CA 91364 USA
| | - Justin A. Bishop
- University of Texas Southwestern Medical Center, Clements University Hospital, UH04.250, 6201 Harry Hines Blvd., Dallas, TX 75390 USA
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Foster JH, Sher A, Seghers V, Poston J, Wells D, Delpassand ES, Potter S, Mahajan P, Venkatramani R. Peptide receptor radionuclide therapy for treatment of metastatic neuroendocrine tumors in children. Pediatr Blood Cancer 2021; 68:e29056. [PMID: 33844446 DOI: 10.1002/pbc.29056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/10/2022]
Abstract
Neuroendocrine tumors (NETs) of the pancreas and midgut are extremely rare in children, and patients presenting with metastatic disease have poor survival. Given this rarity, treatments are extrapolated from guidelines for adults with NET. Recent clinical trials in adults with NETs have shown that the addition of peptide receptor radionuclide therapy (PRRT) with 177 Lu-DOTATATE resulted in a disease control rate of nearly 80%, with minimal side effects. We report our experience using 177 Lu-DOTATATE to treat two pediatric patients with metastatic NET.
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Affiliation(s)
- Jennifer H Foster
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Andrew Sher
- Edward B. Singleton Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Victor Seghers
- Edward B. Singleton Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Jay Poston
- Edward B. Singleton Department of Radiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Donald Wells
- Dell Children's Medical Center, Austin, Texas, USA
| | | | - Samara Potter
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Priya Mahajan
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Rajkumar Venkatramani
- Department of Pediatrics - Section of Hematology/Oncology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
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Doing Great With DOTATATE: Update on GA-68 DOTATATE Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging for Evaluation of Sinonasal Tumors. Top Magn Reson Imaging 2021; 30:151-158. [PMID: 34096898 DOI: 10.1097/rmr.0000000000000289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Sinonasal tumors are relatively rare and radiographically challenging to evaluate due to their wide variety of pathologies and imaging features. However, sinonasal tumors possessing somatostatin receptor overexpression have the benefit of utilizing a multimodality anatomic and functional imaging for a more comprehensive evaluation. This is particularly evident with esthesioneuroblastoma, with computed tomography and magnetic resonance imaging defining the anatomic extent of the tumor, whereas somatostatin receptor imaging, particularly with gallium-68 DOTATATE positron emission tomography/computed tomography, is used to assess the presence of metastatic disease for staging purposes as well as in the surveillance for tumor recurrence. In addition, areas which accumulate gallium-68 DOTATATE are potentially amenable to treatment with peptide receptor radionuclide therapy. In this manner, a combined approach of anatomic and functional imaging is critical for optimal imaging evaluation and treatment strategy of patients with sinonasal tumors.
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Cracolici V, Wang EW, Gardner PA, Snyderman C, Gargano SM, Chiosea S, Singhi AD, Seethala RR. SSTR2 Expression in Olfactory Neuroblastoma: Clinical and Therapeutic Implications. Head Neck Pathol 2021; 15:1185-1191. [PMID: 33929681 PMCID: PMC8633213 DOI: 10.1007/s12105-021-01329-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
Somatostatin receptor 2 (SSTR2) expression has previously been documented in olfactory neuroblastoma (ONB). Here, we fully characterize SSTR2 expression in ONB and correlate staining results with clinicopathologic parameters including Hyams grade. We also assess SSTR2 immunohistochemistry expression in various histologic mimics of ONB to assess its diagnostic functionality. 78 ONBs (51 primary biopsies/excisions and 27 recurrences/metastases) from 58 patients were stained for SSTR2. H-scores based on intensity (0-3 +) and percentage of tumor cells staining were assigned to all cases. 51 histologic mimics were stained and scored in an identical fashion. 77/78 (99%) ONB cases demonstrated SSTR2 staining (mean H-score: 189, range: 0-290). There were no significant differences in staining between primary tumors and recurrences/metastases (mean H-score: 185 vs 198). Primary low-grade ONB had somewhat stronger staining than high-grade tumors (mean H-score: 200 vs 174). SSTR2 expression had no prognostic value when considering disease-free or disease-specific survival. SSTR2 staining is significantly higher in ONB than its histologic mimics (mean H-score: 189 vs 12.9, p < 0.001) suggesting a potential use of the marker in diagnosis of ONB. In conclusion, SSTR2 is consistently expressed in ONB suggesting a role for somatostatin-analog based imaging and therapy in this disease. More generally, SSTR2 may be another marker of neuroendocrine differentiation in ONB.
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Affiliation(s)
- Vincent Cracolici
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- , 9500 Euclid Avenue, L25, Cleveland, OH, USA.
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carl Snyderman
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stacey M Gargano
- Department of Pathology and Laboratory Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Simion Chiosea
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aatur D Singhi
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Raja R Seethala
- Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Roytman M, Tassler AB, Kacker A, Schwartz TH, Dobri GA, Strauss SB, Capalbo AM, Magge RS, Barbaro M, Lin E, Osborne JR, Jana Ivanidze. [68Ga]-DOTATATE PET/CT and PET/MRI in the diagnosis and management of esthesioneuroblastoma: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2058. [PMID: 35854930 PMCID: PMC9241319 DOI: 10.3171/case2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare sinonasal neuroectodermal malignancy with a slow onset of symptoms, favorable 5-year survival, and a propensity for delayed locoregional recurrence. Current treatment options include resection, adjuvant radiotherapy, and/or chemotherapy; however, because of its rarity and location, determining the optimal treatment for ENB has been challenging. OBSERVATIONS ENBs strongly express somatostatin receptors (SSTRs), particularly SSTR2, providing a molecular target for imaging and therapy. LESSONs The authors present a case series of ENBs imaged with [68Ga]-DOTATATE PET/MRI and PET/CT and discuss the emerging role of [68Ga]-DOTATATE PET for ENB diagnosis, staging, and treatment response monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | - Rajiv S. Magge
- Neuro-Oncology, Weill Cornell Medicine, New York, New York
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10
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68Ga-DOTATATE and 18F-FDG PET/CT for the Management of Esthesioneuroblastoma of the Sphenoclival Region. Clin Nucl Med 2020; 45:e363-e364. [PMID: 32558717 DOI: 10.1097/rlu.0000000000003133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a 48-year-old woman with an olfactory neuroblastoma who was referred for accurate staging using PET/CT. The Ga-DOTATATE PET/CT showed a 51 × 32-mm mass with an SUVmax of 7.59 in the sphenoidal sinuses, whereas radiotracer uptake on F-FDG PET/CT was similar to that of brain tissue. Ga-DOTATATE PET/CT might be especially useful in regions with difficult tumor visualization resulting from high background, such as brain tissue. The results of this case may suggest that somatostatin receptor imaging in patients with esthesioneuroblastoma may facilitate the potential application of radiotheranostic agents for the treatment of this aggressive subtype of tumors.
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Hasan OK, Ravi Kumar AS, Kong G, Oleinikov K, Ben-Haim S, Grozinsky-Glasberg S, Hicks RJ. Efficacy of Peptide Receptor Radionuclide Therapy for Esthesioneuroblastoma. J Nucl Med 2020; 61:1326-1330. [DOI: 10.2967/jnumed.119.237990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/10/2020] [Indexed: 11/16/2022] Open
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Abstract
Esthesioneuroblastoma is a rare neoplasm arising from the neural crest cells of olfactory epithelium mostly in the nasal vault. We describe the Ga DOTANOC PET/CT findings of a 44-year-old woman who was operated for right nasal mass diagnosed as paraganglioma in the past and then develop a mass in the right nasal cavity after 2 years which upon surgery diagnosed to be esthesioneuroblastoma on histopathology.
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Lasocki A, Hicks RJ. How we read: the combined use of MRI and novel PET tracers for the characterisation and treatment planning of masses in neuro-oncology. Cancer Imaging 2019; 19:57. [PMID: 31426862 PMCID: PMC6700829 DOI: 10.1186/s40644-019-0241-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/26/2019] [Indexed: 02/01/2023] Open
Abstract
Technical advances in imaging are well demonstrated by MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography). Excellent anatomical detail and a lack of ionising radiation make MRI the standard of care for most neuroimaging indications, and advanced sequences are providing an ever-growing ability for lesion characterisation. PET utilising the tracer fluorine-18 fluorodeoxyglucose is widely used in oncology, while newer PET tracers are able to target a growing number of metabolic pathways and cell membrane receptors. The sequential use of these modalities harnesses the strengths of both, providing complementary diagnostic and therapeutic information.Here we outline the ways in which we use MRI and PET in a complementary manner to improve lesion characterisation in neuro-oncology. Most commonly, an abnormality is detected on either PET or MRI, and the addition of the other modality allows a more confident diagnosis and/or demonstrates additional lesions, guiding treatment decisions and, in some cases, obviating the need for biopsy. These modalities may also be combined to guide the treatment of intracranial masses for which the diagnosis is known, such as neuro-endocrine tumour metastases or meningiomas refractory to conventional therapies.
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Affiliation(s)
- Arian Lasocki
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Grattan St, Melbourne, Victoria, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.
| | - Rodney J Hicks
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Grattan St, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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Bilateral Adrenal Hyperplasia Due to Adrenocorticotropic Hormone-Secreting Esthesioneuroblastoma on FDG PET and 111In-Pentetreotide Scintigraphy. Clin Nucl Med 2018; 43:452-453. [PMID: 29659387 DOI: 10.1097/rlu.0000000000002081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A 53-year-old woman with metastatic esthesioneuroblastoma was referred for FDG PET/CT imaging. FDG PET/CT showed symmetrical uptake in bilaterally enlarged adrenal glands, in addition to abnormal uptake in bone and lymph node metastases. In-pentetreotide scintigraphy was further performed and revealed the lack of adrenal uptake. The patient's serum adrenocorticotropic hormone (ACTH) level was extremely high, suggesting that hyperplastic condition in the adrenal glands due to ACTH stimulation from the metastatic esthesioneuroblastoma was responsible for increased FDG uptake. The combination of FDG PET and In-pentetreotide scintigraphy was useful for the pathophysiological evaluation of ACTH-secreting esthesioneuroblastoma.
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Czapiewski P, Kunc M, Gorczyński A, Haybaeck J, Okoń K, Reszec J, Lewczuk A, Dzierzanowski J, Karczewska J, Biernat W, Turri-Zanoni M, Castelnuovo P, Taverna C, Franchi A, La Rosa S, Sessa F, Klöppel G. Frequent expression of somatostatin receptor 2a in olfactory neuroblastomas: a new and distinctive feature. Hum Pathol 2018; 79:144-150. [PMID: 29807052 DOI: 10.1016/j.humpath.2018.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 12/15/2022]
Abstract
Olfactory neuroblastoma (ONB) is a malignant neuroendocrine neoplasm with a usually slow course, but with considerable recurrence rate. Many neuroendocrine tumors have shown good response to the treatment with somatostatin analogs and somatostatin radioreceptor therapy. In ONBs, there are scarce data on somatostatin-based treatment and the cellular expression of somatostatin receptors (SSTR), the prerequisite for binding and effect of somatostatin on normal and tumor cells. The aim of our study was to investigate the immunohistochemical expression of SSTR2A and SSTR5 in a cohort of 40 ONBs. In addition, tissue microarrays containing 40 high-grade sinonasal carcinomas as well as 6 sinonasal lymphomas, 3 rhabdomyosarcomas, and 3 Ewing sarcomas were evaluated. Volante system was applied for staining evaluation. Thirty cases (75%) were immunopositive for SSTR2A and 3 (7.5%) for SSTR5. Among the 30 SSTR2A-positive ONBs, 19 tumors (63.3%) scored 2+ and 11 (36.7%) scored 3+. All SSTR5-positive ONBs scored 2+. Neither sinonasal carcinomas nor sinonasal small round blue cell neoplasms expressed SSTR2A or SSTR5. The frequent expression of SSTR2A provides a rationale for radioreceptor diagnosis and therapy with SST analogs in ONBs. SSTR2A expression in ONBs is a helpful adjunct in the differential diagnosis of ONBs.
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Affiliation(s)
- Piotr Czapiewski
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland; Department of Pathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | - Michał Kunc
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Adam Gorczyński
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Johannes Haybaeck
- Department of Pathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Neuropathology, Institute of Pathology, Medical University Graz, Graz, Austria
| | - Krzysztof Okoń
- Department of Pathomorphology, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Joanna Reszec
- Department of Medical Pathomorphology, Medical University of Białystok,Białystok, Poland
| | - Anna Lewczuk
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Joanna Karczewska
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Cecilia Taverna
- Section of Anatomic Pathology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - Fausto Sessa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Günter Klöppel
- Department of Pathology, Technische Universität München, München, Germany
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An Uncommon Case of Pediatric Esthesioneuroblastoma Presenting as SIADH: 18F-FDG PET/CT in Staging and Post-Therapeutic Assessment. Diagnostics (Basel) 2018; 8:diagnostics8010008. [PMID: 29342907 PMCID: PMC5871991 DOI: 10.3390/diagnostics8010008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 11/17/2022] Open
Abstract
Esthesioneuroblastoma (ENB) is an uncommon neuroendocrine tumor originating from the olfactory neuroepithelium and accounts for 3–6% of all intranasal tumors [1]. ENBs can be locally aggressive and cause invasion and destruction of surrounding structures. Histological grading and clinical stage at presentation are highly predictive of survival and especially presence of lymph node and distant metastases are determining prognostic factors [2,3,4,5]. Thus, reliable imaging is essential in these patients. Conventional imaging modalities for staging ENB are magnetic resonance imaging (MRI) and computed tomography (CT). However, fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography/CT (18F-FDG PET/CT) has been reported as a valuable adjunct and was found to upstage 36% of ENB patients compared to conventional imaging [6]. We present a case demonstrating the diagnostic work-up and follow-up with 18F-FDG PET/CT in a young patient with ENB with a highly atypical clinical presentation.
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Sabongi JG, Gonçalves MCP, Alves CDC, Alves J, Scapulatempo-Neto C, Moriguchi SM. Lutetium 177-DOTA-TATE therapy for esthesioneuroblastoma: A case report. Exp Ther Med 2016; 12:3078-3082. [PMID: 27882120 DOI: 10.3892/etm.2016.3732] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/21/2016] [Indexed: 11/06/2022] Open
Abstract
Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare malignant tumor that accounts for 3% of all tumors of the nasal cavity. The incidence of ENB is 0.4 cases per million in the general population, and the most common symptoms are nasal obstruction and epistaxis. Previous studies have indicated the presence of somatostatin receptors in this tumor type. Common treatment strategies for ENB include resection and adjuvant radiotherapy and/or chemotherapy (combined treatment); however, the rate of recurrence is high. Treatment of neuroendocrine tumors using radionuclides bound to somatostatin analogues is well established in clinical practice. However, a standard and effective therapeutic approach has not been reported for ENB. The current study described the case of a 74-year-old female with numerous recurrences of ENB following multiple treatments and without possibility of resection. The patient was treated with the radiolabeled-somatostatin analogue, 177Lutetium-DOTA-octreotate (177Lu-DOTA-TATE), which successfully controlled the disease. This suggests that 177Lu-DOTA-TATE is a potential treatment for ENB and may represent an effective alternative and novel therapeutic strategy for this disease.
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Affiliation(s)
- Juliano Guerra Sabongi
- Imaging Medical Center, Division of Nuclear Medicine, Medical Centre of Sorocaba, Sorocaba, SP 18031-480, Brazil
| | | | | | - João Alves
- Department of Nuclear Medicine, Dr Ary Pinheiro Base Hospital, Porto Velho, RO 76804-373, Brazil
| | | | - Sonia Marta Moriguchi
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, São Paulo State University, Botucatu, SP 18618-970, Brazil
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18
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Afshar-Oromieh A, Wolf MB, Kratochwil C, Giesel FL, Combs SE, Dimitrakopoulou-Strauss A, Gnirs R, Roethke MC, Schlemmer HP, Haberkorn U. Comparison of ⁶⁸Ga-DOTATOC-PET/CT and PET/MRI hybrid systems in patients with cranial meningioma: Initial results. Neuro Oncol 2014; 17:312-9. [PMID: 25008094 DOI: 10.1093/neuonc/nou131] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND (68)Ga-DOTATOC-PET/CT is a well-established method for detecting and targeting the volume definition of meningiomas prior to radiotherapy. Moreover, there is evidence that this method is able to detect meningiomas with higher sensitivity than the goldstandard MRI. Since the hybrid PET/MRI scanner became available in the past few years, the next stage of development could consequently evolve by evaluating the feasibility of a hybrid PET/MRI scanner using (68)Ga-DOTATOC for detecting meningiomas. METHODS Fifteen patients received (68)Ga-DOTATOC-PET/CT (0.5 h post injection [p.i.]) followed by PET/MRI 2 hours p.i. Both investigations were analyzed separately and then compared with respect to image quality, detection of intracranial meningiomas, and radiotracer uptake values (RUVs). In addition, ratios between radiotracer uptake in meningiomas and pituitary glands were compared between both PET/CT and PET/MRI. RESULTS Overall, 33 intracranial meningiomas were detected. All were visible with high contrast in both PET/CT and PET/MRI. (68)Ga-DOTATOC-PET/MRI provided flawless image quality without artefacts. Calculated RUV in meningiomas, as well as the ratios of RUVs in meningiomas to those of pituitary glands, were higher in PET/CT. As a result, meningiomas can be distinguished from pituitary glands better in early images. CONCLUSIONS (68)Ga-DOTATOC-PET/MRI provided flawless image quality and presented an ideal combination of high sensitivity/specificity (PET) and the best possible morphological visualization of meningiomas (MRI). In addition, excellent detection of meningiomas is already possible at 0.5 hours p.i. Later images do not improve the distinction between pituitary gland and adjacent meningiomas. However, RUVs need to be carefully compared between both imaging modalities.
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Affiliation(s)
- Ali Afshar-Oromieh
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Maya B Wolf
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Stephanie E Combs
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Antonia Dimitrakopoulou-Strauss
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Regula Gnirs
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Matthias C Roethke
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Heinz P Schlemmer
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital of Heidelberg, Heidelberg, Germany (A.A.-O., C.K., F.L.G., U.H.); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., M.B.W., R.G., M.C.R., H.P.S.); Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.A.-O., A.D.-S.); Department of Radiation Oncology and Therapy, University Hospital of Heidelberg, Heidelberg, Germany (S.E.C.)
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Hoorn EJ, Monserez DA, Fenton RA, Overdevest I, Apperloo AJ, Zietse R, Hardillo JA. Olfactory Neuroblastoma With Hyponatremia. J Clin Oncol 2014; 33:e88-92. [PMID: 24687825 DOI: 10.1200/jco.2013.49.1464] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Robert A Fenton
- Center for Interactions of Proteins in Epithelial Transport, Aarhus University, Aarhus, Denmark
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20
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Broski SM, Hunt CH, Johnson GB, Subramaniam RM, Peller PJ. The added value of 18F-FDG PET/CT for evaluation of patients with esthesioneuroblastoma. J Nucl Med 2012; 53:1200-6. [PMID: 22728262 DOI: 10.2967/jnumed.112.102897] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The purpose of this study was to evaluate the clinical utility of (18)F-FDG PET/CT in esthesioneuroblastoma staging and restaging and quantify the additional benefit of PET/CT to conventional imaging. METHODS A retrospective review was performed with institutional review board approval for patients with a diagnosis of esthesioneuroblastoma who underwent PET/CT from 2000 to 2010. PET/CT results were retrospectively reviewed by 2 radiologists who were unaware of the clinical and imaging data. Positive imaging findings were classified into 3 categories: local disease, cervical nodal spread, and distant metastasis. All conventional imaging performed in the 6 mo preceding PET/CT, and the medical records, were reviewed to determine the potential added value. RESULTS Twenty-eight patients (mean age, 52.3 ± 10 y; range, 23-81 y) were identified who underwent a total of 77 PET/CT examinations. Maximum standardized uptake value (SUVmax) was 8.68 ± 4.75 (range, 3.6-23.3) for the primary tumor and 8.57 ± 6.46 (range, 1.9-27.2) for the metastatic site. There was no clear association between primary tumor SUVmax and tumor grade (P = 0.30). Compared with conventional imaging, PET/CT changed disease stage or altered clinical management in 11 (39%) of 28 esthesioneuroblastoma patients. Of these, 10 (36%) of 28 were upstaged on the basis of their PET/CT studies. Cervical nodal metastases were found in 5 (18%) of 28, local recurrence in 2 (7%) of 28, cervical nodal and distant metastases in 2 (7%) of 28, and distant metastases in 1 (4%) of 28. One patient (4%) was downstaged after negative findings on PET/CT. CONCLUSION PET/CT is a useful adjunct to conventional imaging in the initial staging and restaging of esthesioneuroblastoma by detecting nodal and distant metastatic disease not demonstrated by conventional imaging and identifying local recurrence hidden by treatment changes on conventional imaging.
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21
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Afshar-Oromieh A, Giesel FL, Linhart HG, Haberkorn U, Haufe S, Combs SE, Podlesek D, Eisenhut M, Kratochwil C. Detection of cranial meningiomas: comparison of ⁶⁸Ga-DOTATOC PET/CT and contrast-enhanced MRI. Eur J Nucl Med Mol Imaging 2012; 39:1409-15. [PMID: 22669255 DOI: 10.1007/s00259-012-2155-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE PET imaging with somatostatin receptor ligands, such as (68)Ga-DOTATOC, is a well-established method for detection and target volume definition of meningiomas prior to radiotherapy. Since DOTATOC PET delivers a higher contrast between meningiomas and surrounding tissues than MRI, we conducted a retrospective analysis to compare the diagnostic accuracy of contrast-enhanced MRI (CE-MRI) with (68)Ga-DOTATOC PET/CT in patients with cranial meningiomas prior to radiotherapy. METHODS Over a period of 6 years, 134 patients (20-82 years of age, 107 women and 27 men) underwent cranial CE-MRI and (68)Ga-DOTATOC PET/CT. To compare the two methods, the lesions considered typical of meningiomas visually were counted and analysed with respect to their location and SUVmax. RESULTS In the 134 patients investigated by both modalities, 190 meningiomas were detected by (68)Ga-DOTATOC PET/CT and 171 by CE-MRI. With knowledge of the PET/CT data, the MRI scans were reinvestigated, which led to the detection of 4 of the 19 incidental meningiomas, resulting in an overall detection rate of 92 % of the meningioma lesions that were found by PET/CT. CONCLUSION Ga-DOTATOC PET/CT demonstrated an improved sensitivity in meningioma detection when compared to CE-MRI. Tumours adjacent to the falx cerebri, located at the skull base or obscured by imaging artefacts or calcification are particularly difficult to detect by MRI. Therefore (68)Ga-DOTATOC PET/CT may provide additional information in patients with uncertain or equivocal results on MRI or could help to confirm a diagnosis of meningioma based on MRI or could help to confirm MRI-based diagnosis of meningiomas in cases of biopsy limitations. It is possible that not only radiotherapy and surgical planning, but also follow-up strategies would benefit from this imaging modality.
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Affiliation(s)
- Ali Afshar-Oromieh
- Department of Nuclear Medicine, University Hospital of Heidelberg, INF 400, 69120 Heidelberg, Germany.
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Kane AJ, Sughrue ME, Rutkowski MJ, Aranda D, Mills SA, Buencamino R, Fang S, Barani IJ, Parsa AT. Posttreatment prognosis of patients with esthesioneuroblastoma. J Neurosurg 2010; 113:340-51. [PMID: 20345216 DOI: 10.3171/2010.2.jns091897] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There is no Class I evidence to guide the appropriate management of esthesioneuroblastoma (EN). Most data currently guiding treatment come from small- or modest-sized series gathered at individual centers that have concluded that surgery with radiotherapy is the preferred treatment. In this study, the authors summarize the published literature on treatment outcomes in patients with EN. The objective was to ascertain what variables predict prognosis in these patients and to determine the relative effect of different therapies. METHODS The authors identified 205 published studies containing treatment outcomes for surgery, radiotherapy, chemotherapy, or multimodal treatment. Using Kaplan-Meier analysis, the survival of patients who received surgery was compared with that in those who received surgery and radiotherapy. Additionally, Kadish staging was compared with low- and high-grade Hyams criteria to assess for subgroup prognostic significance in survival differences. RESULTS Nine hundred fifty-six patients met the inclusion criteria, with a median follow-up time of 3 years. Kaplan-Meier analysis demonstrated no difference in survival between patients who underwent surgery alone and those who underwent surgery plus radiotherapy at 5 years (78 vs 75%) or 10 years (67 vs 61%, respectively) (p = 0.3). Univariate analysis demonstrated worse survival in cases involving Kadish Grade C tumors, Hyams Grade 3 and 4 tumors, and in patients older than 65 years of age. Multivariate analysis demonstrated that Hyams Grade 3 and 4 lesions carried significant risk (proportional hazard = 4.83, p < 0.001) with 5- and 10-year survival of 47 and 31%. CONCLUSIONS A biopsy should always be obtained in cases suspected of EN because histology is a strong prognostic indicator and will help guide appropriate treatment. Unimodal surgery and combined surgery/radiotherapy appear to be of equivalent efficacy with respect to survival in patients with EN. Chemotherapy should be considered in high-grade EN.
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Affiliation(s)
- Ari J Kane
- Department of Neurological Surgery, University of California, San Francisco, California 94143, USA
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Abstract
The sinonasal malignancies of putative neuroendocrine origin-esthesioneuroblastoma, sinonasal neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, and sinonasal small cell carcinoma-are uncommon malignancies that frequently present with locally advanced disease. Pathologic distinction between these entities can be difficult, but is important to guide management. These malignancies require complex multimodality treatment and are best managed by multidisciplinary teams in major centers that have expertise in sinonasal malignancies.
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Affiliation(s)
- Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag No 1, A'Beckett Street, Melbourne 8006, Australia.
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Mankoff DA, Link JM, Linden HM, Sundararajan L, Krohn KA. Tumor receptor imaging. J Nucl Med 2008; 49 Suppl 2:149S-63S. [PMID: 18523071 DOI: 10.2967/jnumed.107.045963] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Tumor receptors play an important role in carcinogenesis and tumor growth and have been some of the earliest targets for tumor-specific therapy, for example, the estrogen receptor in breast cancer. Knowledge of receptor expression is key for therapy directed at tumor receptors and traditionally has been obtained by assay of biopsy material. Tumor receptor imaging offers complementary information that includes evaluation of the entire tumor burden and characterization of the heterogeneity of tumor receptor expression. The nature of the ligand-receptor interaction poses a challenge for imaging--notably, the requirement for a low molecular concentration of the imaging probe to avoid saturating the receptor and increasing the background because of nonspecific uptake. For this reason, much of the work to date in tumor receptor imaging has been done with radionuclide probes. In this overview of tumor receptor imaging, aspects of receptor biochemistry and biology that underlie tumor receptor imaging are reviewed, with the estrogen-estrogen receptor system in breast cancer as an illustrative example. Examples of progress in radionuclide receptor imaging for 3 receptor systems--steroid receptors, somatostatin receptors, and growth factor receptors-are highlighted, and recent investigations of receptor imaging with other molecular imaging modalities are reviewed.
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Affiliation(s)
- David A Mankoff
- Division of Nuclear Medicine, University of Washington, Seattle, Washington, USA.
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