Wk 4, Case 3 - Review
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Something worth talking about in pona net.
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It's not like the gyp nets, not like the gi
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and pancreatic nets in gi pancreatic nets.
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It's, it's clear cut when it's grade one will differentiate.
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Grade two will differentiate it.
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They express MARTA receptors
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and they will be notate positive.
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Buton nets are not the same. pnet.
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Sometimes e even the well differentiated low grade nets,
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sometimes they don't express myostatin receptors.
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So, um, when, when we have a patient sent to us
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and they have, uh, pulmonary neuroendocrin tumor,
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if the, if we do ate
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and it doesn't show up, we cannot say
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that this means this is a high grade neuroendocrine cancer.
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We cannot say that because it is known
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that there's a percentage
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of the B monitoring neuroendocrin tumor
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that do not express low grade.
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Low grade well differentiated,
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but they do not express neur, uh, SW statin receptors.
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This is a known fact. So be careful with this in gib nets.
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It, it's like it's a rule.
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Anytime it's a well differentiated low grade,
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it expresses somatostatin receptors.
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That's it. All of them are in poni.
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No, it, it is not a rule.
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There is a percentage of them that are well differentiated,
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low grade do not express the somatostatin receptors,
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which means they are not gonna show up in dotatate,
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which means they're not eligible for, uh, targeted our PRT.
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Right? Although the FDA approval was actually forgiveness
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for, not for, um, pulmonary,
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but honestly, we treat many, many sites treat of off-label
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with, uh, PRT.
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But of course, you always theranostics theranostics like
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concept before treatment.
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You have to do your, um, scan to assess for eligibility.
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Right. Okay, so let's go and see. Here is our primary site.
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Nice and lean here.
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Mass, central mass, beautiful central mass
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posing compression, the bronchus
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and of course beautiful associated obstructive changes.
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Right? Beautiful. Nice intensely. SSA avid, right?
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Because it's, it's low grade will differentiate it.
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Um, then when you look here in the,
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in the pit only everything else is clean.
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There's nothing else. So there's no metastatic,
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there's no SSA of it metastatic lymph node
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because there might be tiny little node that is metastatic
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that the number of cells didn't reach our detectability.
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Although with that much activity in the primary side,
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I doubt because the, the, the solution limitation
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that we see with FDG, it's, I don't see
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that it is really holding up
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with the low grade neuro, the tumors.
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If it's really avid like this, most of the time
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even the tiny, like two millimeter lesion
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would be intensely avid. Because,
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Because it's very, very hot as we see.
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So the size, size limitation doesn't hold up with,
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uh, when it's well differentiated, um, low grade
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and it's really suppressing, uh, neuroreceptors.
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Otherwise there's nothing else in this patient.
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No metastatic disease.
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No, no, no distant metastatic disease in this patient.
Riham El Khouli, MD
Associate Professor of Radiology, Chief, Division of Nuclear Medicine/Molecular Imaging & Radiotheranostics
University of Kentucky
Michael F. Shriver, MD
Director of Nuclear Medicine
Proscan-NCH Imaging
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