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Gabiache G, Zadro C, Rozenblum L, Vezzosi D, Mouly C, Thoulouzan M, Guimbaud R, Otal P, Dierickx L, Rousseau H, Trepanier C, Dercle L, Mokrane FZ. Image-Guided Precision Medicine in the Diagnosis and Treatment of Pheochromocytomas and Paragangliomas. Cancers (Basel) 2023; 15:4666. [PMID: 37760633 PMCID: PMC10526298 DOI: 10.3390/cancers15184666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
In this comprehensive review, we aimed to discuss the current state-of-the-art medical imaging for pheochromocytomas and paragangliomas (PPGLs) diagnosis and treatment. Despite major medical improvements, PPGLs, as with other neuroendocrine tumors (NETs), leave clinicians facing several challenges; their inherent particularities and their diagnosis and treatment pose several challenges for clinicians due to their inherent complexity, and they require management by multidisciplinary teams. The conventional concepts of medical imaging are currently undergoing a paradigm shift, thanks to developments in radiomic and metabolic imaging. However, despite active research, clinical relevance of these new parameters remains unclear, and further multicentric studies are needed in order to validate and increase widespread use and integration in clinical routine. Use of AI in PPGLs may detect changes in tumor phenotype that precede classical medical imaging biomarkers, such as shape, texture, and size. Since PPGLs are rare, slow-growing, and heterogeneous, multicentric collaboration will be necessary to have enough data in order to develop new PPGL biomarkers. In this nonsystematic review, our aim is to present an exhaustive pedagogical tool based on real-world cases, dedicated to physicians dealing with PPGLs, augmented by perspectives of artificial intelligence and big data.
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Affiliation(s)
- Gildas Gabiache
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Charline Zadro
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Laura Rozenblum
- Department of Nuclear Medicine, Sorbonne Université, AP-HP, Hôpital La Pitié-Salpêtrière, 75013 Paris, France
| | - Delphine Vezzosi
- Department of Endocrinology, Rangueil University Hospital, 31400 Toulouse, France
| | - Céline Mouly
- Department of Endocrinology, Rangueil University Hospital, 31400 Toulouse, France
| | | | - Rosine Guimbaud
- Department of Oncology, Rangueil University Hospital, 31400 Toulouse, France
| | - Philippe Otal
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Lawrence Dierickx
- Department of Nuclear Medicine, IUCT-Oncopole, 31059 Toulouse, France;
| | - Hervé Rousseau
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
| | - Christopher Trepanier
- New York-Presbyterian Hospital/Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Laurent Dercle
- New York-Presbyterian Hospital/Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Fatima-Zohra Mokrane
- Department of Radiology, Rangueil University Hospital, 31400 Toulouse, France (F.-Z.M.)
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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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3
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Taïeb D, Hicks RJ, Hindié E, Guillet BA, Avram A, Ghedini P, Timmers HJ, Scott AT, Elojeimy S, Rubello D, Virgolini IJ, Fanti S, Balogova S, Pandit-Taskar N, Pacak K. European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 2019; 46:2112-2137. [PMID: 31254038 PMCID: PMC7446938 DOI: 10.1007/s00259-019-04398-1] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results. METHODS Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals. CONCLUSION Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (68Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (123I)/iodine-131 (131I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 rue Saint-Pierre, 13005, Marseille Cedex 05, France.
| | - Rodney J Hicks
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Elif Hindié
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, Bordeaux University Hospitals, Pessac, France
| | - Benjamin A Guillet
- Department of Radiopharmacy, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Anca Avram
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Pietro Ghedini
- Nuclear Medicine Unit, Medicina Nucleare Metropolitana, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Henri J Timmers
- Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Saeed Elojeimy
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Transfusional Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Irène J Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefano Fanti
- Nuclear Medicine Unit, Medicina Nucleare Metropolitana, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Sona Balogova
- Department of Nuclear Medicine, Comenius University and St. Elisabeth Oncology Institute, Heydukova 10, 81250, Bratislava, Slovakia
- Department of Nuclear Medicine, Hôpital Tenon Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karel Pacak
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Batchala PP, Dyer A, Mukherjee S, Rehm PK. Lateral ectopic thyroid mimics carotid body tumor on Indium-111 pentetreotide scintigraphy. Clin Imaging 2019; 58:46-49. [PMID: 31238185 DOI: 10.1016/j.clinimag.2019.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022]
Abstract
A 34-year old woman with past history of anxiety, depression, and hypothyroidism resulting from prior total thyroidectomy for multinodular goiter presented with complaints of palpitations, sweating, and tachycardia. Clinical examination revealed a painless right lateral neck mass. USG/CT of the neck revealed the soft tissue mass located at the right carotid bifurcation. A subsequent Indium-111 pentetreotide somatostatin receptor scintigraphy (SRS) demonstrated tracer uptake in the mass. Hence, secretory carotid body tumor/paraganglioma was strongly suspected. However, post-surgical histopathological specimen revealed only benign thyroid follicles indicative of lateral ectopic thyroid with no evidence of neuroendocrine cells or malignancy. This case highlights the importance of considering lateral ectopic thyroid, a very rare entity, in the differential diagnosis for carotid bifurcation masses. Also highlighted is the false positivity from normal but ectopic thyroid tissue on Indium-111 pentetreotide SRS mimicking a paraganglioma.
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Affiliation(s)
- Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Anthony Dyer
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Patrice K Rehm
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
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5
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Paraganglioma. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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6
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DÍAZ-GONZÁLEZ LG, PÉREZ-LÓPEZ B, FRANCO-RODRÍGUEZ Y, MUÑOZ-HERRERA Á, TAMAYO-ALONSO P. Paraganglioma mediastínico detectado con gammagrafía SPECT-TC con 111In-pentetreótida. Descripción de un caso. REVISTA ORL 2017. [DOI: 10.14201/orl201784.15783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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7
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Taïeb D, Wolf KI, Pacak K. Recent advances in the imaging of pheochromocytomas and paragangliomas. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017. [DOI: 10.2217/ije-2017-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pheochromocytoma and paraganglioma (PPGL) belong to the family of neural crest cell-derived neoplasms, and can be widely distributed throughout the body. Over the past few years, with respect to these tumors, precision medicine has offered the promise of improved patient care. Through tumor visualization and identification of molecular signatures, nuclear medicine is capable of playing a key role in PPGL precision medicine. 68Ga-labeled somatostatin analogs were found to improve the detection and staging of head and neck paragangliomas, SDHx-related PPGLs and metastatic PPGLs regardless of genetic background. For PPGLs associated with increased kinase signaling or HIF2A mutations, 18F-fluorodihydroxyphenylalanine appears to be the most informative radiopharmaceutical. This review emphasizes the current theranostic approaches and future perspective related to PPGL imaging options.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 13005 Marseille, France
| | - Katherine I Wolf
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
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8
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Guichard JP, Fakhry N, Franc J, Herman P, Righini CA, Taieb D. Morphological and functional imaging of neck paragangliomas. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:243-248. [PMID: 27887852 DOI: 10.1016/j.anorl.2016.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review the optimal techniques for localization and characterization of neck paragangliomas (PGL). MATERIAL AND METHODS Systematic review of the literature from the PubMed/Medline database. RESULTS Neck PGL are hypervascular tumours essentially arising from paraganglionic tissue situated at the carotid bifurcation (carotid body) and along the vagus nerve. Morphological and functional imaging are indicated to confirm the diagnosis, identify multifocal disease and for local and regional staging. MR angiography is the noninvasive technique of choice. CT scan and especially CT angiography are excellent alternatives for diagnosis and staging. Conventional arteriography remains useful preoperatively for embolization and occlusion tests. Functional imaging allows localization and characterization of PGLs. Somatostatin receptor scintigraphy (SRS) was the reference imaging technique for staging of sporadic PGLs. The indications for PET imaging have been extended over recent years in parallel with the development of new tracers such as [18F]-FDOPA PET or 68Gallium-labelled DOTA peptides. 68Gallium-labelled DOTA peptides has become the first-line imaging modality in the evaluation of cervical PGLs, regardless of the genetic background. CONCLUSION Morphological and functional imaging is essential for the staging of neck PGL.
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Affiliation(s)
- J-P Guichard
- Department of Neurovascular Imaging, H"pital LariboisiSre, AP-HP, Universit, Paris 7 Denis Diderot, 75010 Paris, France
| | - N Fakhry
- Service d'ORL et chirurgie cervicofaciale, Aix-Marseille université, CHU La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - J Franc
- Department of Neurovascular Imaging, H"pital LariboisiSre, AP-HP, Universit, Paris 7 Denis Diderot, 75010 Paris, France
| | - P Herman
- Department of Head and Neck surgery, LariboisiSre Hospital, AP-HP, University Paris-Diderot Paris 7, 75010 Paris, France
| | - C-A Righini
- Pôle médecine, Université des Alpes, CHU des Alpes, Clinique Universitaire d'ORL, Pôle PALCROS, 38043 Grenoble, France; UFR médecine, université Joseph-Fourier, domaine de la Merci, 38700 La Tronche, France
| | - D Taieb
- Service central de biophysique et de médecine nucléaire, Aix-Marseille université, CHU La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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9
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Corrales CE, Fischbein N, Jackler RK. Imaging innovations in temporal bone disorders. Otolaryngol Clin North Am 2015; 48:263-80. [PMID: 25769351 DOI: 10.1016/j.otc.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The development of new imaging techniques coupled with new treatment algorithms has created new possibilities in treating temporal bone diseases. This article provides an overview of recent imaging innovations that can be applied to temporal bone diseases. Topics covered include the role of magnetic resonance (MR) diffusion-weighted imaging in cholesteatomas and skull base epidermoids, whole-body molecular imaging in paragangliomas of the jugular foramen, and MR arterial spin labeling perfusion for dural arteriovenous fistulas and arteriovenous malformations.
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Affiliation(s)
- C Eduardo Corrales
- Department of Otology, Neurotology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Nancy Fischbein
- Departments of Radiology, Otolaryngology-Head and Neck Surgery, Neurology, Neurosurgery and Radiation Oncology, Stanford University Medical Center, 300 Pasteur Drive, Room S-047, Stanford, CA 94305, USA
| | - Robert K Jackler
- Division of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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10
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Dublin AB, Bobinski M. Imaging Characteristics of Olfactory Neuroblastoma (Esthesioneuroblastoma). J Neurol Surg B Skull Base 2015; 77:1-5. [PMID: 26949582 DOI: 10.1055/s-0035-1564053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This presentation outlines the clinical and imaging characteristics of esthesioneuroblastoma.
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Affiliation(s)
- Arthur B Dublin
- Department of Radiology, Section of Neuroradiology, University of California-Davis Medical Center, Sacramento, California, United States
| | - Matthew Bobinski
- Department of Radiology, Section of Neuroradiology, University of California-Davis Medical Center, Sacramento, California, United States
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11
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Castillo-Berrio C, Castrillón M, Zelaya F, Ruíz D, Loira F, Nogueiras J, López A, Guitián R, Outomuro J, Serena A, Campos L. 111In-octreotide SPECT–CT in head and neck paragangliomas. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Castillo-Berrio C, Castrillón M, Zelaya F, Ruíz D, Loira F, Nogueiras JM, López A, Guitián R, Outomuro J, Serena A, Campos LM. (111)In-octreotide SPECT-CT in head and neck paragangliomas. Rev Esp Med Nucl Imagen Mol 2015; 34:321-4. [PMID: 25858499 DOI: 10.1016/j.remn.2015.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/22/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
Head and neck paragangliomas are rare neuroendocrine tumors expressing somatostatin receptors on their cell surface, particularly subtype 2. Due to this distinctive feature, images can be obtained in Nuclear Medicine using synthetic analogues of somatostatin, mainly octreotide, which allow selective display by planar scintigraphy, SPECT-CT or PET-CT imaging after radiolabeling with (111)In or (68)Ga. Three cases have been selected and presented from a series of patients that illustrate the utility of SPECT-CT studies with (111)In-octreotide in the diagnosis and monitoring of this type of tumor. These are characterization at initial diagnosis, staging, and detection of local recurrence or metastasis, with added value with respect to anatomical images (nuclear magnetic resonance, computed axial tomography, angiography), for example in the differentiation between functional tissue or scar in patients who had previously undergone surgery.
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Affiliation(s)
- C Castillo-Berrio
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España.
| | - M Castrillón
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - F Zelaya
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - D Ruíz
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - F Loira
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - J M Nogueiras
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - A López
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - R Guitián
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - J Outomuro
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - A Serena
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
| | - L M Campos
- Servicio de Medicina Nuclear, Hospital Meixoeiro, Vigo, Pontevedra, España
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13
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Taïeb D, Kaliski A, Boedeker CC, Martucci V, Fojo T, Adler JR, Pacak K. Current approaches and recent developments in the management of head and neck paragangliomas. Endocr Rev 2014; 35:795-819. [PMID: 25033281 PMCID: PMC4167435 DOI: 10.1210/er.2014-1026] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors belonging to the family of pheochromocytoma/paraganglioma neoplasms. Despite advances in understanding the pathogenesis of these tumors, the growth potential and clinical outcome of individual cases remains largely unpredictable. Over several decades, surgical resection has long been the treatment of choice for HNPGLs. However, increasing experience in various forms of radiosurgery has been reported to result in curative-like outcomes, even for tumors localized in the most inaccessible anatomical areas. The emergence of such new therapies challenges the traditional paradigm for the management of HNPGLs. This review will assist and guide physicians who encounter patients with such tumors, either from a diagnostic or therapeutic standpoint. This review will also particularly emphasize current and emerging knowledge in genetics, imaging, and therapeutic options as well as the health-related quality of life for patients with HNPGLs.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine (D.T.), La Timone University Hospital, CERIMED, Aix-Marseille Univ, F-13385 Marseille, France; Department of Radiation Oncology (A.K.), Besançon University Hospital, F-25030 Besançon, France; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), HELIOS Hanseklinikum Stralsund, D-18435 Stralsund, Germany; Department of Otorhinolaryngology/Head and Neck Surgery (C.C.B.), University Hospital, Freiburg, Germany; Program in Reproductive and Adult Endocrinology (V.M., K.P.), Eunice Kennedy Shriver National Institute of Child Health and Human Development and Medical Oncology Branch (T.F.), National Institutes of Health, Bethesda, Maryland 20892; Department of Neurosurgery (J.R.A.), Stanford Hospital and Clinics, Stanford University, Stanford, California 94305
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14
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Hodin R, Lubitz C, Phitayakorn R, Stephen A. Diagnosis and management of pheochromocytoma. Curr Probl Surg 2014; 51:151-87. [DOI: 10.1067/j.cpsurg.2013.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
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15
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Hussain I, Husain Q, Baredes S, Eloy JA, Jyung RW, Liu JK. Molecular genetics of paragangliomas of the skull base and head and neck region: implications for medical and surgical management. J Neurosurg 2014; 120:321-30. [DOI: 10.3171/2013.10.jns13659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Paragangliomas are rare, slow-growing tumors that frequently arise in the head and neck, with the carotid bodies and temporal bone of the skull base being the most common sites. These neoplasms are histologically similar to pheochromocytomas that form in the adrenal medulla and are divided into sympathetic and parasympathetic subtypes based on functionality. Skull base and head and neck region paragangliomas (SHN-PGs) are almost always derived from parasympathetic tissue and rarely secrete catecholamines. However, they can cause significant morbidity by mass effect on various cranial nerves and major blood vessels. While surgery for SHN-PG can be curative, postoperative deficits and recurrences make these lesions challenging to manage. Multiple familial syndromes predisposing individuals to development of paragangliomas have been identified, all involving mutations in the succinate dehydrogenase complex of mitochondria. Mutations in this enzyme lead to a state of “pseudohypoxia” that upregulates various angiogenic, survival, and proliferation factors. Moreover, familial paraganglioma syndromes are among the rare inherited diseases in which genomic imprinting occurs. Recent advances in gene arrays and transcriptome/exome sequencing have identified an alternate mutation in sporadic SHN-PG, which regulates proto-oncogenic pathways independent of pseudohypoxia-induced factors. Collectively these findings demonstrate that paragangliomas of the skull base and head and neck region have a distinct genetic signature from sympathetic-based paragangliomas occurring below the neck, such as pheochromocytomas. Paragangliomas serve as a unique model of primarily surgically treated neoplasms whose future will be altered by the elucidation of their genomic complexities. In this review, the authors present an analysis of the molecular genetics of SHN-PG and provide future directions in patient care and the development of novel therapies.
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Affiliation(s)
| | | | - Soly Baredes
- 2Otolaryngology–Head and Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- 1Departments of Neurological Surgery and
- 2Otolaryngology–Head and Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Robert W. Jyung
- 2Otolaryngology–Head and Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - James K. Liu
- 1Departments of Neurological Surgery and
- 2Otolaryngology–Head and Neck Surgery, and
- 3Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
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Taïeb D, Varoquaux A, Chen CC, Pacak K. Current and future trends in the anatomical and functional imaging of head and neck paragangliomas. Semin Nucl Med 2013; 43:462-73. [PMID: 24094713 PMCID: PMC3792493 DOI: 10.1053/j.semnuclmed.2013.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Head and neck paragangliomas (HNPGLs) account for approximately 3% of all paragangliomas (PGLs). Most often, HNPGLs are benign, nonsecreting, and slowly progressing. The initial physical examination and biochemical diagnosis usually adds very little to the proper diagnosis of these tumors, and, therefore, radiologists and nuclear medicine physicians play a pivotal role in providing the initial diagnosis, the locoregional staging, and the plan for detecting potential multicentric or metastatic lesions. Based on several current studies, the most accurate use of HNPGL-specific initial and subsequent imaging modalities must be guided by the knowledge of genetics and the specifically measured biochemical profile of these tumors for the proper management of these patients. Thus, this short review article presents the application of the most up-to-date anatomical and functional imaging approaches to HNPGLs tightly linked to the clinical management of these patients. Based on the most recent studies, 18F-FDOPA PET/CT has been shown to be a useful addition to anatomical imaging in the preoperative localization and molecular assessment of HNPGLs. It is estimated that the frequency of metabolically active PGLs on 18F-FDOPA PET/CT in this region is higher than 90%. For patients with hereditary PGL syndromes, (18)F-FDG-PET/CT should be reserved. Imaging of somatostatin receptors using Octreoscan or 68Ga-labeled somatostatin analogues plays an important role for selecting patients for targeted radiation therapy. This review also concludes that it is expected that in the near future, these patients will indeed benefit from new diagnostic approaches based on the identification of new targets by molecular profiling studies that will result in the development of novel PGL-specific radiopharmaceuticals.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille Univ, Marseille, France. Phone: +33-4-91-38-55-58, Fax: +33-4-91-38-47-69,
| | - Arthur Varoquaux
- Department of Radiology, La Timone University Hospital, Aix-Marseille Univ, Marseille, France. Phone: +33-4-91-38-56-75, Fax: +33-4-91-38-58-88,
| | - Clara C Chen
- Nuclear Medicine, Department of Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA. Phone: (301) 496-5675, Fax: (301) 496-0114,
| | - Karel Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Pepe G, Bombardieri E, Lorenzoni A, Chiti A. Single-photon emission computed tomography tracers in the diagnostics of neuroendocrine tumors. PET Clin 2013; 9:11-26. [PMID: 25029930 DOI: 10.1016/j.cpet.2013.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Different imaging strategies have been developed targeting the peculiar features of neuroendocrine tumors (NETs). Metabolic characteristics and receptor expression on the tumor surface have been studied, and expertise and knowledge are increasing as a result of the implementation of fusion imaging and the development of more detailed positron emission tomography tracers. Scintigraphic study of NETs is the most diffused and convenient technique for evaluating patients suspected to have NETs.
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Affiliation(s)
- Giovanna Pepe
- Nuclear Medicine Department, Humanitas Clinical and Research Institute, Via A. Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Emilio Bombardieri
- Nuclear Medicine Department, National Cancer Institute, Via G. venezian 1, Milan 20133, Italy
| | - Alice Lorenzoni
- Nuclear Medicine Department, National Cancer Institute, Via G. venezian 1, Milan 20133, Italy
| | - Arturo Chiti
- Nuclear Medicine Department, Humanitas Clinical and Research Institute, Via A. Manzoni 56, 20089 Rozzano, Milan, Italy.
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Choudhri AF, Parmar HA, Morales RE, Gandhi D. Lesions of the skull base: imaging for diagnosis and treatment. Otolaryngol Clin North Am 2013; 45:1385-404. [PMID: 23153754 DOI: 10.1016/j.otc.2012.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article provides a summary of how to approach the imaging analysis of lesions of the anterior, central, and posterior skull base. The primary focus is tumors and tumor-mimickers, and representative examples are shown to differentiate the features of lesions that can occur in the same location.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
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19
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Taïeb D, Timmers HJ, Hindié E, Guillet BA, Neumann HP, Walz MK, Opocher G, de Herder WW, Boedeker CC, de Krijger RR, Chiti A, Al-Nahhas A, Pacak K, Rubello D. EANM 2012 guidelines for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 2012; 39:1977-95. [PMID: 22926712 DOI: 10.1007/s00259-012-2215-8] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Radionuclide imaging of phaeochromocytomas (PCCs) and paragangliomas (PGLs) involves various functional imaging techniques and approaches for accurate diagnosis, staging and tumour characterization. The purpose of the present guidelines is to assist nuclear medicine practitioners in performing, interpreting and reporting the results of the currently available SPECT and PET imaging approaches. These guidelines are intended to present information specifically adapted to European practice. METHODS Guidelines from related fields, issued by the European Association of Nuclear Medicine and the Society of Nuclear Medicine, were taken into consideration and are partially integrated within this text. The same was applied to the relevant literature, and the final result was discussed with leading experts involved in the management of patients with PCC/PGL. The information provided should be viewed in the context of local conditions, laws and regulations. CONCLUSION Although several radionuclide imaging modalities are considered herein, considerable focus is given to PET imaging which offers high sensitivity targeted molecular imaging approaches.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, France.
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20
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Timmers HJLM, Taieb D, Pacak K. Current and future anatomical and functional imaging approaches to pheochromocytoma and paraganglioma. Horm Metab Res 2012; 44:367-72. [PMID: 22399235 PMCID: PMC4714588 DOI: 10.1055/s-0031-1299712] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
After establishing a biochemical diagnosis, pheochromocytomas and extra-adrenal paragangliomas (PPGLs) can be localized using different anatomical and functional imaging modalities. These include computed tomography, magnetic resonance imaging, single-photon emission computed tomography (SPECT) using 123I-metaiodobenzylguanidine or 111In-DTPA-pentetreotide, and positron emission tomography (PET) using 6-[18F]-fluorodopamine (18F-FDA), 6-[18F]-fluoro-l-3,4-dihydroxyphenylalanine (18F-DOPA), and 2-[18F]-fluoro-2-deoxy-d-glucose. We review the currently available data on the performance of anatomical imaging, SPECT, and PET for the detection of (metastatic) PPGL as well as parasympathetic head and neck paragangliomas. We show that there appears to be no 'gold-standard' imaging technique for all patients with (suspected) PPGL. A tailor-made approach is warranted, guided by clinical, biochemical, and genetic characteristics. In the current era of a growing number of PET tracers, PPGL imaging has moved beyond tumor localization towards functional characterization of tumors.
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Affiliation(s)
- H. J. L. M. Timmers
- Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - D. Taieb
- Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France
| | - K. Pacak
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Boedeker CC. Paragangliomas and paraganglioma syndromes. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc03. [PMID: 22558053 PMCID: PMC3341580 DOI: 10.3205/cto000076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Paragangliomas are rare tumors of neural crest origin. They are benign in the majority of cases and are characterized by a strong vascularisation. In the head and neck region they most commonly occur as carotid body tumors. Jugulotympanic and especially vagal paragangliomas are seen less frequently. Complete surgical resection represents the only curative treatment option even though resection of locally advanced tumors regularly results in lesions of the lower cranial nerves and major vessels. Appoximately 30% of all head and neck paragangliomas (HNPs) are hereditary and associated with different tumor syndromes. The paraganglioma syndromes 1, 3 and 4 (PGL 1, 3 and 4) make up the majority of those familial cases. PGL 1 is associated with mutations of the succinate dehydrogenase subunit D (SDHD) gene, PGL 3 is caused by SDHC and PGL 4 by SDHB gene mutations. Multiple HNPs and the occurance of HNPs together with pheochromocytomas are seen in SDHD as well as SDHB mutation carriers. In patients with SDHB mutations the risk for the development of malignant paraganglial tumors is significantly higher compared to SDHC and SDHD patients as well as patients with sporadic tumors. SDHC mutation carriers almost exclusively present with benign HNP that are unifocal in the majority of cases. The role of transmission is autosomal dominant for all three symptoms. Interestingly, there is a “parent-of-origin-dependent-inheritance” in subjects with SDHD gene mutations. This means that the disease phenotype may only become present if the mutation is inherited through the paternal line. We recommend screening for mutations of the genes SDHB, SDHC and SDHD in patients with HNPs. Certain clinical parameters can help to set up the order in which the three genes should be tested.
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Taïeb D, Neumann H, Rubello D, Al-Nahhas A, Guillet B, Hindié E. Modern Nuclear Imaging for Paragangliomas: Beyond SPECT. J Nucl Med 2012; 53:264-74. [DOI: 10.2967/jnumed.111.098152] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Abstract
Radiolabeled peptides targeted against receptors on the cell surface have been shown to be remarkably specific and effective in the diagnosis and therapy of malignant disease. Much of the early work in this field took place outside the United States, but in recent years the research effort within the United States has accelerated. Most of the initial studies in the United States focused on somatostatin receptor ligands. (111)In-pentetreotide was approved in 1994 and has been used extensively in the diagnosis and management of a wide variety of neuroendocrine tumors, particularly carcinoid. This work was extended to (99m)Tc-labeled analogs, and the most successful, (99m)Tc-depreotide, was approved in 1999. This agent was found to be accurate in the diagnosis of lung cancer, but it was not particularly successful because it was supplanted by (18)F-FDG imaging with positron tomography. More recently, studies with (68)Ga-labeled somatostatin analogs were initiated in the United States. This effort was delayed relative to that in other parts of the world because of difficulty in obtaining the necessary generators and regulatory uncertainty, both of which are less of a problem currently. Several ligands are being developed to image melanoma through targeting of the melanocyte-stimulating hormone receptor. Other ligands are being developed to use the arginine-glycine-aspartate oligopeptide to target angiogenesis and to use bombesin analogs to target the gastrin-releasing peptide receptor for the diagnosis and potential therapy of prostate cancer. Peptide dimers that target 2 receptors simultaneously are also being constructed, potentially increasing the selectivity of the approach significantly. Radiopeptide therapy has been explored with these ligands, initially with high-dose (111)In-pentetreotide. This step has been followed by U.S. participation in several trials with (90)Y-, (177)Lu-, and (188)Re-labeled analogs. Some of these agents are now available clinically outside the United States, and it is important to design and conduct the appropriate trials so that this therapy can be offered within the United States.
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Affiliation(s)
- Michael M Graham
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
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Colen TY, Mihm FG, Mason TP, Roberson JB. Catecholamine-secreting paragangliomas: recent progress in diagnosis and perioperative management. Skull Base 2011; 19:377-85. [PMID: 20436839 DOI: 10.1055/s-0029-1224771] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Catecholamine-secreting paragangliomas (CSPs) present challenges for the managing team of surgeons and anesthesiologists. Without proper preoperative management and planning, the patient is at high risk for complications and significant morbidity. A review of the literature looking at all aspects of the care of patients with CSP was performed to provide a consensus on the comprehensive care of these difficult patients. A case study is also provided to illustrate the management algorithm. Specific recommendations are made with regards to preoperative workup, including serum and urine testing, tumor localization, angiography, and embolization. Preoperative and intraoperative management techniques by the surgical and anesthesiology teams are discussed, including pharmaceutical interventions and fluid management. Aspects of postoperative care are also discussed. Management of patients with CSP requires significant attention to detail by a multidisciplinary team of surgeons and anesthesiologists. By following the recommendations included within this article, the morbidity associated with removal of these tumors can be significantly reduced or eliminated.
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Affiliation(s)
- Tahl Y Colen
- California Ear Institute, E. Palo Alto, California
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Abstract
Neuroendocrine tumors (NET) are a heterogeneous group of tumors that arise from neuroendocrine cells. These tumors may arise from various organs, including lung, thymus, thyroid, stomach, duodenum, small bowel, large bowel, appendix, pancreas, adrenal, and skin. Most are well differentiated and have the ability to produce biogenic amines and various hormones. NET usually occur sporadically but they also be associated with various familial syndromes. For the vast majority of NET, surgical resection is the treatment of choice whenever feasible. Localization of NET prior to surgery and for staging and follow-up relies on both anatomic and functional imaging modalities. In fact, the unique secretory characteristics of these tumors lend themselves to imaging by molecular imaging modalities, which can target specific metabolic pathways or receptors. Neuroendocrine cells have a variety of such target receptors and pathways for which radiopharmaceuticals have been developed, including [(123)I/(131)I]-metaiodobenzylguanidine (MIBG), [(111)In]pentetreotide, [(68)Ga] somatostatin analogs, [(18)F] fluorodeoxyglucose (FDG), [(11)C/(18)F] dihydroxyphenylalanine (DOPA), [(11)C] 5-hydroxytryptophan (5-HTP) (99m)Tc pentavalent dimercaptosuccinic acid ([(99m)Tc] (V) DMSA, and [(18)F] fluorodopamine (FDA). Here, we review the molecular imaging approaches for NET using various radiopharmaceuticals.
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Affiliation(s)
- Jorge A Carrasquillo
- Nuclear Medicine Service, Radiology Department Memorial Sloan-Kettering, New York, NY, USA.
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Kimura N, Tateno H, Saijo S, Horii A. Familial cervical paragangliomas with lymph node metastasis expressing somatostatin receptor type 2A. Endocr Pathol 2010; 21:139-43. [PMID: 19936639 DOI: 10.1007/s12022-009-9098-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report a case of familial, bilateral cervical paragangliomas (PGs) with lymph node metastasis. Patient I-1 is a 56-year-old man with a right carotid body tumor and a left vagal PG. Patient II-1 is a 29-year-old woman and the daughter of Patient I-1; she had a left carotid body tumor with regional lymph node metastasis. Histology of all the tumors showed the typical pattern of PGs, i.e., a zellballen pattern composed of chief cells positive for chromogranin A, and sustentacular cells positive for S100 protein. The Ki-67 labeling index was 1% to 3% in these PGs in both the primary and the metastatic tumors. Immunohistochemical analysis showed expression of somatostatin receptor (sstr) type 2A, but was negative for sstr type 5. Genomic mutation in succinate dehydrogenase type D was confirmed in both patients. Here, we present a case of familial PGs, and discuss the cases with special reference to pathologic diagnosis, genetics, and treatment.
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Affiliation(s)
- Noriko Kimura
- Department of Clinical Research, Pathology Section, Japan National Hospital Organization, Hakodate Hospital, 16-18 Kawahara-cho, Hakodate, Hokkaido, Japan, 041-8512.
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Dullaart RPF, van der Horst-Schrivers ANA, Koopmans KP. New imaging approaches to phaeochromocytomas and paragangliomas. Clin Endocrinol (Oxf) 2010; 72:568-9; author reply 569. [PMID: 19769625 DOI: 10.1111/j.1365-2265.2009.03705.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lincke T, Singer J, Kluge R, Sabri O, Paschke R. Relative quantification of indium-111 pentetreotide and gallium-68 DOTATOC uptake in the thyroid gland and association with thyroid pathologies. Thyroid 2009; 19:381-9. [PMID: 19355828 DOI: 10.1089/thy.2008.0389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent data suggest that increased somatostatin receptor (SSTR) expression is detectable in several thyroid diseases. This raises the question as to the specificity and pathophysiologic relevance of these findings. Therefore, we systematically evaluated Indium-111 (In-111) pentetreotide scintigraphies and Gallium-68 (Ga-68) DOTA-Phe(1)-Tyr(3)-Octreotide (DOTATOC) positron emission tomography (PET) scans for thyroid radiotracer uptake. METHODS Relative binding of In-111 pentetreotide in the thyroid was measured by region of interest (ROI) technique in 4-hour and 24-hour post-injection (p.i.) planar images of 73 patients undergoing In-111 pentetreotide scintigraphy. Ga-68 DOTATOC PET scans of 77 patients were analyzed by ROI technique applied to coronal slices of 1 cm (0.39 inch) thickness with highest uptake in the thyroid region. RESULTS A basal indium In-111 and Ga-68 DOTATOC uptake was found in normal thyroid glands. Hot nodules, disseminated thyroid autonomy, and most cases of active Hashimoto's disease as well as goiters and nodular thyroids showed increased In-111 pentetreotide and/or Ga-68 DOTATOC uptake. Higher relative In-111 pentetreotide uptake in the 24-hour p.i. images as compared to the 4-hour p.i. images except for patients after thyroidectomy indicates specific receptor binding in the thyroid. CONCLUSIONS The increased In-111 pentetreotide and Ga-68 DOTATOC uptake in active Hashimoto's disease is most likely related to the lymphocytic infiltration of the thyroid. However, the physiologic or pathophysiologic relevance of the increased In-111 pentetreotide and Ga-68 DOTATOC uptake in normal thyroid glands, hot and cold nodules, and goiters and nodular thyroids remain to be determined.
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Affiliation(s)
- Thomas Lincke
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
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Ilias I, Pacak K. A clinical overview of pheochromocytomas/paragangliomas and carcinoid tumors. Nucl Med Biol 2009; 35 Suppl 1:S27-34. [PMID: 18707631 DOI: 10.1016/j.nucmedbio.2008.04.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 01/02/2023]
Abstract
Pheochromocytomas/paragangliomas are rare tumors; most are sporadic. Biochemical proof of disease is better with measurement of plasma metanephrines and less cumbersome than determinations in urine; its implementation is expanding. Anatomical imaging with computed tomography or magnetic resonance imaging should be followed by functional (nuclear medicine) imaging: chromaffin tumor-specific methods are preferred. Treatment is surgical; for nonoperable disease other options are available. Overall 5-year survival is 50%. Carcinoid tumors derive from serotonin-producing enterochromaffin cells in the fore-, mid- or hindgut. Biochemical screening (and follow-up) is done with measurements of 5-hydroxyindoloacetic acid in urine. For most carcinoids, functional imaging is better than other modalities in localizing primary tumors. Surgery is the treatment of choice; nonresectable tumors are treated with somatostatin analogs or chemotherapy. Overall 5-year survival for patients with carcinoids is 67%.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, E. Venizelou Hospital, Athens GR-11521, Greece.
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Ilias I, Chen CC, Carrasquillo JA, Whatley M, Ling A, Lazúrová I, Adams KT, Perera S, Pacak K. Comparison of 6-18F-fluorodopamine PET with 123I-metaiodobenzylguanidine and 111in-pentetreotide scintigraphy in localization of nonmetastatic and metastatic pheochromocytoma. J Nucl Med 2008; 49:1613-9. [PMID: 18794260 DOI: 10.2967/jnumed.108.052373] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED We compared functional imaging modalities including PET with 6-(18)F-fluorodopamine ((18)F-DA) with (123)I-metaiodobenzylguanidine ((123)I-MIBG) and somatostatin receptor scintigraphy (SRS) with (111)In-pentetreotide in nonmetastatic and metastatic pheochromocytoma (PHEO). METHODS We studied 25 men and 28 women (mean age +/- SD, 44.2 +/- 14.2 y) with biochemically proven nonmetastatic (n = 17) or metastatic (n = 36) PHEO. Evaluation included anatomic imaging with CT or MRI and functional imaging that included at least 2 nuclear medicine modalities: (18)F-DA PET, (123)I-MIBG scintigraphy, or SRS. Sensitivity of functional imaging versus anatomic imaging was assessed on a per-patient and a per-region basis. RESULTS For this available cohort, on a per-patient basis overall sensitivity (combined for nonmetastatic and metastatic PHEO) was 90.2% for (18)F-DA PET, 76.0% for (123)I-MIBG scintigraphy, and 22.0% for SRS. On a per-region basis, overall sensitivity was 75.4% for (18)F-DA PET, 63.4% for (123)I-MIBG scintigraphy, and 64.0% for SRS. CONCLUSION If available, (18)F-DA PET should be used in the evaluation of PHEO, because it is more sensitive than (123)I-MIBG scintigraphy or SRS. If (18)F-DA PET is not available, (123)I-MIBG scintigraphy (for nonmetastatic or adrenal PHEO) and SRS (for metastatic PHEO) should be the first alternative imaging methods to be used.
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Affiliation(s)
- Ioannis Ilias
- Reproductive Biology and Adult Endocrinology Program, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
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Radioiodinated MIBG in paraganglioma and pheochromocytoma: previous results and early experiences using no-carrier-added MIBG. Nucl Med Biol 2008. [DOI: 10.1016/j.nucmedbio.2008.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Screening for familial paragangliomas. Oral Oncol 2008; 44:532-7. [DOI: 10.1016/j.oraloncology.2007.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 06/25/2007] [Accepted: 06/25/2007] [Indexed: 11/20/2022]
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Neves F, Huwart L, Jourdan G, Reizine D, Herman P, Vicaut E, Guichard JP. Head and neck paragangliomas: value of contrast-enhanced 3D MR angiography. AJNR Am J Neuroradiol 2008; 29:883-9. [PMID: 18339724 DOI: 10.3174/ajnr.a0948] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A rapid and accurate MR imaging technique would be beneficial to assess paragangliomas in the head and neck and to distinguish them from other lesions. The purpose of this study was to determine whether the combination of elliptic centric contrast-enhanced MR angiography (CE-MRA) and unenhanced and enhanced spin-echo imaging (conventional MR imaging) is more accurate than conventional MR imaging alone to assess paragangliomas in the head and neck. MATERIALS AND METHODS Three radiologists retrospectively and independently reviewed CE-MRA and conventional MR imaging in 27 patients with suspected paragangliomas. The overall image quality and the probability of paraganglioma were recorded. The results of each technique and their combination were analyzed for sensitivity and specificity. Receiver operating characteristic (ROC) analyses were performed by using histologic analysis, imaging, and/or clinical findings as the reference standard. RESULTS Forty-six lesions were found in 27 patients. In the assessment of paragangliomas, the combination of conventional MR imaging and CE-MRA was significantly superior to conventional MR imaging alone. Sensitivity and specificity respectively were the following: for CE-MRA, 100% and 94%; and for conventional MR imaging, 94% and 41%. The specificity of CE-MRA was significantly higher than that of conventional MR imaging (P = .004). There was good-to-excellent interobserver agreement for the paraganglioma probability with CE-MRA (nonweighted kappa, 0.67-0.77), whereas there was fair-to-good interobserver agreement with conventional MR imaging (nonweighted kappa, 0.50-0.65). CONCLUSION In combination with conventional MR imaging, CE-MRA yields an excellent diagnostic value for the assessment of head and neck paragangliomas; hence, the 2 techniques should be regarded as complementary.
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Affiliation(s)
- F Neves
- Department of Neuroradiology, Groupe Hospitalier Lariboisière-Fernand-Widal AP-HP, Paris, France
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Matiasek K, Cronau M, Schmahl W, Gerhards H. Imaging Features and Decision Making in Retrobulbar Neuroendocrine Tumours in Horses ? Case Report and Review of Literature. ACTA ACUST UNITED AC 2007; 54:302-6. [PMID: 17650150 DOI: 10.1111/j.1439-0442.2007.00955.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 25-year-old Haflinger gelding was evaluated for chronic-progressive unilateral exophthalmos. Ultrasonographic investigation and magnetic resonance (MR) imaging revealed a retrobulbar space-occupying mass to be the cause of eyeball displacement. Ultrasonographic features were not sufficient to specify the type and extension of the lesion. Magnetic resonance scans, however, clearly displayed an infiltrative intracranial growth pattern but sparing of orbital soft tissues. Based on MR appearance, tentative diagnosis of an orbital soft tissue neoplasia was made and subsequently confirmed by histopathological investigation. The latter revealed a poorly differentiated neuroendocrine tumour. Retrospectively, MR changes resembled those seen with neuroendocrine neoplasms of the human skull. Even if histopathology remains to be elucidated by cytological or histological inspection, MR imaging of equine orbital tumours should provide the criteria necessary for evaluating the therapeutic options and associated prognosis.
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Affiliation(s)
- K Matiasek
- Institute of Veterinary Pathology, Chair of General Pathology & Neuropathology, Ludwig-Maximilians University, Veterinarstr. 13, D-80539 Munich, Germany.
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Zapanti E, Ilias I. Pheochromocytoma: Physiopathologic Implications and Diagnostic Evaluation. Ann N Y Acad Sci 2006; 1088:346-60. [PMID: 17192579 DOI: 10.1196/annals.1366.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Pheochromocytoma (PHEO) is a chromaffin cell tumor embryologically arising from the neural crest tissue. The dominant secretory products of PHEO are catecholamines: noradrenaline (norepinephrine), adrenaline (epinephrine), and to a lesser extent dopamine. In addition to catecholamines, PHEO cells also elaborate and release several neuropeptides and inflammatory cytokines which can exert intra-adrenal and extra-adrenal systemic effects and cause characteristic clinical syndromes. In a concise review we present the intra-adrenal and extra-adrenal pathophysiologic implications of PHEO and the nuclear medicine modalities that permit functional imaging of physiological processes and help localize these tumors. The specific pathways of synthesis, metabolism, and inactivation of catecholamines (of PHEOs and paragangliomas) can be used as means to develop suitable tracers for positron emission tomography (PET) ligands. In this review we focus on imaging with PET using [(18)F]-fluorodopamine, [(18)F]-fluorohydroxyphenylalanine, [(11)C]-epinephrine, or [(11)C]-hydroxyephedrine and examine how functional imaging can often complement traditional anatomical imaging modalities and other scintigraphic techniques.
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Affiliation(s)
- Evangelia Zapanti
- First Department of Endocrinology, Alexandra hospital, Athens, GR-11528, Greece.
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Plouin PF, Gimenez-Roqueplo AP. Initial work-up and long-term follow-up in patients with phaeochromocytomas and paragangliomas. Best Pract Res Clin Endocrinol Metab 2006; 20:421-34. [PMID: 16980203 DOI: 10.1016/j.beem.2006.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Catecholamine-producing tumours may arise in the adrenal medulla (phaeochromocytomas) or in extra-adrenal chromaffin cells (paragangliomas). The most specific and sensitive diagnostic test is the determination of plasma or urinary metanephrine levels. The tumour can be located by computed tomography, magnetic resonance imaging and metaiodo-benzylguanidine scintigraphy. Patients are treated by tumour resection. Phaeochromocytomas and paragangliomas may be sporadic or the result of several genetic diseases: multiple endocrine neoplasia type 2, neurofibromatosis 1, von Hippel-Lindau disease, succinate dehydrogenase-phaeochromocytoma-paraganglioma syndrome. Familial cases are diagnosed earlier and are more frequently bilateral and recurrent than sporadic cases. About 10% of tumours are malignant, either at initial surgery or during follow-up. Recurrences and malignancy are more frequent in cases with large or extra-adrenal tumours and in the succinate dehydrogenase subunit B-related phaeochromocytoma-paraganglioma syndrome. Patients should be followed up indefinitely, particularly if they have familial or extra-adrenal tumours.
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Affiliation(s)
- Pierre-François Plouin
- Hypertension Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France.
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Shulkin BL, Ilias I, Sisson JC, Pacak K. Current Trends in Functional Imaging of Pheochromocytomas and Paragangliomas. Ann N Y Acad Sci 2006; 1073:374-82. [PMID: 17102106 DOI: 10.1196/annals.1353.041] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Most pheochromocytomas/paragangliomas should be evaluated with anatomical imaging (computed tomography or magnetic resonance imaging) followed by functional imaging (nuclear medicine modalities). Functional imaging assures that the tumor is indeed a pheochromocytoma/paraganglioma and enables more thorough localization, especially detecting as many lesions as possible (in particular for metastatic disease). Functional imaging for pheochromocytomas/paragangliomas, can use radiolabeled ligands specific for pathways of synthesis, metabolism, and inactivation of catecholamines or nonspecific ligands. In an overview of the available nuclear medicine modalities, we summarize the accumulated experience and recommend when functional imaging should be applied to patients with pheochromocytoma/paraganglioma.
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Affiliation(s)
- Barry L Shulkin
- Division of Nuclear Medicine, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA, and Department of Pharmacology, Medical School, University of Patras, Rion, Greece
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Suárez C, Rodrigo JP, Ferlito A, Cabanillas R, Shaha AR, Rinaldo A. Tumours of familial origin in the head and neck. Oral Oncol 2006; 42:965-78. [PMID: 16857415 DOI: 10.1016/j.oraloncology.2006.03.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 03/08/2006] [Indexed: 12/15/2022]
Abstract
Individuals with inherited cancer syndromes are at significant risk of developing both benign and malignant tumours as a result of a germline mutation in a specific tumour suppressor gene. Tumours of familial origin are a rare event in the head and neck but despite this, they deserve a growing interest. Familial paragangliomas are most of the time limited to the paraganglionar system, but also may be part of different syndromic associations. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis in the search of SDHB, SDHC and SDHD mutations in families of affected patients plays a front-line diagnostic role, leading to more efficient patient management. Multiple endocrine neoplasias type 1 are characterized by the simultaneous occurrence of at least two of the three main related endocrine tumours: parathyroid, enteropancreatic and anterior pituitary. These tumours arise from inactivating germline mutations in the MEN-1 gene. No clear correlation of MEN-1 genotype with genotype has emerged to date, and MEN-1 mutation testing in tumours is not used clinically because it have not implications for tumour staging. Multiple endocrine neoplasia type 2 is due to a germline mutation in the RET proto-oncogene. Hallmarks of MEN-2A (the commonest phenotypic variant) include medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. The most central clinical difference with MEN-1 is that the associated cancer can be prevented or cured by early thyroidectomy in mutation carriers. Individuals with neurofibomatosis type 1 present early in life with pigmentary abnormalities, skinfold freckling and iris hamartomas, as result of NF1 gene mutation. Neurofibromatosis 2 is caused by inactivating mutations of the NF2 gene, and is characterized by the development of nervous system tumours (mainly bilateral vestibular schwannomas), ocular abnormalities, and skin tumours. The molecular genetic basis of nasopharyngeal carcinomas remains unknown, but there is evidence for the linkage of these tumours to chromosome 3p. Finally, the high rate of p16 mutations in squamous cell carcinomas and the association of p16 with familial melanoma propose p16 as an ideal candidate gene predisposing to familial squamous cell carcinomas. The elucidation of the cellular processes affected by dysfunction in familial tumours of the head and neck may serve to identify potential targets for future therapeutic interventions.
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Affiliation(s)
- Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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Nguyen BD, Roarke MC, Nelson KD, Chong BW. F-18 FDG PET/CT staging and posttherapeutic assessment of esthesioneuroblastoma. Clin Nucl Med 2006; 31:172-4. [PMID: 16495744 DOI: 10.1097/01.rlu.0000200735.55296.73] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Gujrathi CS, Donald PJ. Current trends in the diagnosis and management of head and neck paragangliomas. Curr Opin Otolaryngol Head Neck Surg 2005; 13:339-42. [PMID: 16282761 DOI: 10.1097/01.moo.0000188707.35494.6b] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the diagnosis and management of head and neck paragangliomas. RECENT FINDINGS The review will focus on three main areas of interest: genetics, newer imaging modalities, and management with radiation therapy. SUMMARY The succinate dehydrogenase enzyme complex is important in the pathogenesis of paragangliomas. Magnetic resonance angiography and functional imaging have become very helpful in diagnosing these tumors. Surgery is still the mainstay of therapy, but conventional or stereotactic radiotherapy seems to be a very safe option in very large or inoperable tumors.
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Affiliation(s)
- Chetan S Gujrathi
- Medical Center, University of California-Davis, 2315 Stockton Boulevard, Sacramento, CA 95817, USA.
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Abstract
OBJECTIVES/HYPOTHESIS Peptide receptor imaging with Indium pentetreotide is useful in the diagnosis of diffuse neuroendocrine system tumors (DNEST) of the head and neck. Uses of Indium pentetreotide scintigraphy include tumor and metastases detection, familial tumor screening, and surveillance for recurrence. Using target to background ratios (TBR) could generate a comparative scale for these tumors. STUDY DESIGN A retrospective study evaluated the size, TBR, conventional imaging, and outcomes of patients imaged with Indium pentetreotide scintigraphy for suspected head and neck DNEST. METHODS Patients with head and neck tumors imaged by Indium pentetreotide scintigraphy during a nine-year period were reviewed. Data analyzed were age, sex, scintigraphy, pathology, and conventional radiology. Tumor data included dimension, multiplicity, metastases, and tumor and brain counts. RESULTS Fifty-three patients underwent 58 scans. The sensitivity and specificity were 93% and 92%. Several different DNEST were successfully evaluated, including familial paragangliomas and multiple paragangliomas. TBRs were variable depending on type of DNEST. CONCLUSIONS Indium pentetreotide scintigraphy is accurate in determining the presence of paragangliomas, carcinoid tumors, esthesioneuroblastomas, small cell neuroendocrine tumors, andmetastases. It is an excellent surveillance tool. Screening patients for familial paragangliomas can be accomplished. No reliable comparative scale to distinguish amongst the various DNEST could be developed using TBR.
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Affiliation(s)
- David Myssiorek
- Department of Otolaryngology and Communicative Disorders, The Long Island Jewish Medical Center, The Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, New York, USA.
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Ilias I, Shulkin B, Pacak K. New functional imaging modalities for chromaffin tumors, neuroblastomas and ganglioneuromas. Trends Endocrinol Metab 2005; 16:66-72. [PMID: 15734147 DOI: 10.1016/j.tem.2005.01.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nuclear medicine modalities use radiolabeled ligands that either follow metabolic pathways or act on cellular receptors. Thus, they permit functional imaging of physiological processes and help to localize sites such as tumors that harbor pathological events. The application of positron emission tomography (PET) ligands to the specific pathways of synthesis, metabolism and inactivation of catecholamines found in chromaffin tumors, neuroblastomas and ganglioneuromas can be used to provide a more thorough localization of these types of tumor. Recent advances have been made in functional imaging to localize pheochromocytomas, paragangliomas, neuroblastomas and ganglioneuromas, including approaches based on PET with [(18)F]fluorodopamine, [(18)F]fluorohydroxyphenylalanine, [(11)C]epinephrine or [(11)C]hydroxyephedrine. Such functional imaging can complement computed tomography or magnetic resonance imaging and other scintigraphic techniques to localize these tumors before surgical or medical therapeutic approaches are considered.
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Affiliation(s)
- Ioannis Ilias
- Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1109, USA
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