NET G1 of the appendix with peritoneal dissemination in a young patient

Overview

Neuroendocrine neoplasms represent a heterogeneous group of tumors affecting patients across a wide range of age categories. This group also includes well-differentiated neuroendocrine tumors (NET) of the gastrointestinal tract, which typically show strong expression of somatostatin receptor subtype 2 (SSTR2) in both, primary and metastatic lesions. This feature is routinely used for diagnostic imaging as well as for targeted therapy.

In an 18-year-old patient disseminated peritoneal disease of unknown origin was incidentally detected during an attempted laparoscopic appendectomy for suspected acute apendicitis. A suspicion of a NET G1 was raised based on the sampled peritoneal lesion. The patient was subsequently referred to the Department of Nuclear Medicine at IKEM, where ^99mTc-HYNIC-TOC (Tektrotyd) scintigraphy demonstrated involvement of the appendix and the peritoneum. The patient subsequently underwent right hemicolectomy, omentectomy and metastasectomy at the Thomayer University Hospital, followed by histopathological verification of the diagnosis, including confirmation of SSTR2 expression.

This case report highlights the importance of nuclear medicine imaging within a multidisciplinary approach to the diagnosis, staging and therapeutic management of patients with NETs. The potential role of selective radionuclide therapy in advanced disease is discussed.

Keywords:

scintigraphy – histology – NET G1 – Tektrotyd