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CASE REPORT
Year : 2018  |  Volume : 17  |  Issue : 1  |  Page : 65-66

Incidental detection of asymptomatic brain metastases on 18F-fluoride positron emission tomography/computed tomography and 68Ga DOTANOC positron emission tomography/computed tomography in a patient with concomitant breast carcinoma and a pancreatic neuroendocrine tumor


Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool, Merseyside, L7 8XP, UK

Date of Web Publication5-Jan-2018

Correspondence Address:
Ruth Brown
Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside, L7 8XP
UK
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DOI: 10.4103/wjnm.WJNM_10_17

PMID: 29398971

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   Abstract 


A 54-year-old female treated for locally advanced ductal breast carcinoma was also diagnosed with a pancreatic neuroendocrine tumour. A staging 68Ga DOTANOC positron emission tomography/computed tomography (PET/CT) demonstrated somatostatin receptor-positive foci within the brain parenchyma. A whole body 18F-fluoride PET/CT also demonstrated several foci of low-grade tracer uptake in the brain. Magnetic resonance imaging confirmed several cerebral and cerebellar metastases. This case highlights the need to be aware of each tumor's metastatic profile and the careful attention required for thoroughly evaluating imaging in the presence of multiple pathologies. Furthermore, such incidental findings can have significant treatment and prognostic implications.

Keywords: 18F-fluoride positron emission tomography/computed tomography, 68Ga DOTANOC positron emission tomography/computed tomography, brain metastases, breast carcinoma, neuroendocrine tumor


How to cite this article:
Brown R, Chuah PS, Panagiotidis E, Vinjamuri S. Incidental detection of asymptomatic brain metastases on 18F-fluoride positron emission tomography/computed tomography and 68Ga DOTANOC positron emission tomography/computed tomography in a patient with concomitant breast carcinoma and a pancreatic neuroendocrine tumor. World J Nucl Med 2018;17:65-6

How to cite this URL:
Brown R, Chuah PS, Panagiotidis E, Vinjamuri S. Incidental detection of asymptomatic brain metastases on 18F-fluoride positron emission tomography/computed tomography and 68Ga DOTANOC positron emission tomography/computed tomography in a patient with concomitant breast carcinoma and a pancreatic neuroendocrine tumor. World J Nucl Med [serial online] 2018 [cited 2020 Sep 26];17:65-6. Available from: http://www.wjnm.org/text.asp?2018/17/1/65/222279




   Case Presentation Top


A 54-year-old female underwent two whole body positron emission tomography/computed tomography (PET/CT) scans before a gadolinium-enhanced magnetic resonance imaging (MRI) of her brain. [Figure 1] shows the abnormalities found in the brain parenchyma detected by the 18F-fluoride PET/CT bone scan, which are more subtle when compared with the somatostatin receptor imaging in [Figure 2], using 68Ga DOTANOC PET/CT. The two PET/CT scans were performed within a 2-week interval and demonstrate a similar pattern of tracer uptake within the brain parenchyma.
Figure 1: 18F-fluoride positron emission tomography/computed tomography bone scan - abnormalities found in the brain parenchyma

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Figure 2: 68Ga DOTANOC positron emission tomography/computed tomography - abnormal uptake in brain parenchyma

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[Figure 1] and [Figure 2] both correspond to the postgadolinium MRI findings as shown in [Figure 3]. The histology of the neuroendocrine tumor (NET) demonstrated a Ki67 index of 4.2%, and the size of the NET reduced following the chemotherapy given for the breast cancer making it unlikely to be the source of the cerebral metastases, although brain metastases from NETs have been reported.[1] Breast cancer has a recognized predisposition to metastasize to the brain;[2],[3] the original histology of the T3 N3, estrogen receptor negative, human epidermal receptor 2 positive invasive ductal carcinoma had a high Ki67 index of 40%, making it more likely to be the responsible primary tumor.[4],[5] Breast cancer has been shown to express somatostatin receptors accounting for the uptake demonstrated on the 68Ga DOTANOC PET/CT.[6],[7] In this case, there was no abnormality on the low-dose CTs that accompanied both PET scans and there was an absence of calcification in the areas of increased 18F-fluoride uptake within the brain. Extra-osseous findings including brain metastases from breast carcinoma and other primary malignancies have demonstrated uptake on 18F-fluoride PET/CT in the absence of calcification, similar to this case.[8],[9] The patient was subsequently admitted for targeted radiotherapy to her cerebral metastases following discussion at multidisciplinary team meetings.
Figure 3: Magnetic resonance imaging confirming cerebral metastases

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Carreras C, Kulkarni H, Baum R. Rare metastases detected by 68Ga-somatostatin receptor PET/CT in patients with neuroendocrine tumors. In: Baum RP, Rösch F, editors. Theranostics, Gallium-68, and Other Radionuclides. Recent Results in Cancer Research. 194. Berlin, Heidelberg: Springer Berlin Heidelberg; 2013. p. 379-84.  Back to cited text no. 1
    
2.
Cheng X, Hung MC. Breast cancer brain metastases. Cancer Metastasis Rev 2007;26:635-43.  Back to cited text no. 2
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3.
Evans AJ, James JJ, Cornford EJ, Chan SY, Burrell HC, Pinder SE, et al. Brain metastases from breast cancer: identification of a high-risk group. Clin Oncol (R Coll Radiol) 2004;16:345-9.  Back to cited text no. 3
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4.
Yerushalmi R, Woods R, Ravdin PM, Hayes MM, Gelmon KA. Ki67 in breast cancer: prognostic and predictive potential. Lancet Oncol 2010;11:174-83.  Back to cited text no. 4
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5.
Inwald EC, Klinkhammer-Schalke M, Hofstädter F, Zeman F, Koller M, Gerstenhauer M, et al. Ki-67 is a prognostic parameter in breast cancer patients: results of a large population-based cohort of a cancer registry. Breast Cancer Res Treat 2013;139:539-52.  Back to cited text no. 5
    
6.
Al-Nahhas A, Win Z, Szyszko T, Singh A, Nanni C, Fanti S, et al. Gallium-68 PET: a new frontier in receptor cancer imaging. Anticancer Res 2007;27:4087-94.  Back to cited text no. 6
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7.
Kwekkeboom D, Krenning EP, de Jong M. Peptide receptor imaging and therapy. J Nucl Med 2000;41:1704-13.  Back to cited text no. 7
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8.
Li Y, Tafti BA, Shaba W, Berenji GR. Extraosseus uptake of F-18 fluoride in the primary malignancy and cerebral metastasis in a case of non-small-cell lung cancer. Clin Nucl Med 2011;36:609-11.  Back to cited text no. 8
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9.
Tripathi M, Jaimini A, Singh N, Jain N, D'Souza M, Kaur P, et al. F-18 flurodeoxyglucose negative, F-18 fluoride accumulating in a brain metastasis in a treated case of carcinoma of the breast. Clin Nucl Med 2009;34:287-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Brain Metastases of a Neuroendocrine Tumor Visualized by 68Ga-DOTATATE PET/CT
Sebastian Hoberück,Enrico Michler,Klaus Zöphel,Ivan Platzek,Jörg Kotzerke,Claudia Brogsitter
Clinical Nuclear Medicine. 2019; 44(1): 50
[Pubmed] | [DOI]



 

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